Loading
A medical coder, often referred to as a clinical coding officer, diagnostic coder, clinical coder, or nosologist, is a member of the healthcare information management team whose primary responsibilities include analyzing medical records, clinical statements and assigning standard codes based on International classification fixture. The health data generated are an essential component of health information management, and they are used for a variety of purposes by local, state, and federal governments, private healthcare providers, and international organizations, including medical and health services research, epidemiological studies, resource allocation for healthcare, case mix management, public health programming, medical billing, and public awareness campaigns. A medical coder translates details from a patient's medical documents, such as physician's notes, lab reports, procedures, and diagnoses into universal medical codes to maintain accurate medical records. Healthcare providers and insurance companies use these standardized codes for billing and record-keeping.
There are currently five major medical coding classification systems that are used to identify and manage medical codes — ICD-11, ICD-10-CM, ICD-10-PCS, CPT and HCPCS Level II.
There are three series of codes used in Medical Coding that MF use every day as a medical coder.
The International Classification of Diseases (ICD) are a set of codes that helps to maintain a standardised vocabulary for defining the causes of injury, disease, as well as death. This code was created in the late 1940s by the World Health Organization (WHO). It has undergone many updates since it was first created. The ICD code revision shown by the number after "ICD" is the most recent version. For instance, the ICD-11-CM code is now in use in the United States. The ICD code has undergone 10 revisions as of this point. The prefix "-CM" stands for "clinical modification," which refers to a group of adjustments made by the Center for Medicare and Medicaid Studies' (CMS) National Center for Health Statistics (NCHS).
Clinical change significantly increases the number of diagnosis codes. This expanded scope provides coders with much more flexibility and specificity, which is essential to the profession. In general, the ICD-11 contains 14,000 codes. ICD-11-CM, its clinical modification, contains over 68,000 codes.ICD codes are used to reflect both the patient's medical condition and a doctor's diagnosis report. The use of these is for billing. Coders are responsible for making sure that the operation being charged is reasonable in light of the provided diagnosis.
The ICD-11-CM is a seven-character alpha-numeric code. Each code starts with a letter, then has two digits after it. ICD-11-CM's "category" is represented by the first three characters. The classification identifies the broad category of injury or disease. The category is followed by a subcategory and the decimal point. Two subcategories that further describe the cause, occurrence; location, severity, and nature of the injury or sickness are then listed after this. The extension is referred to as the last character.
The extension denotes the nature of the contact. In other words, if a doctor checks a patient for the first time for this particular condition/injury/disease, it is referred to as a "initial encounter." A "subsequent encounter" is any encounter that occurs after the first. Patients who return for "sequelae" are those who experience symptoms from an earlier disease.
The Current Procedure Terminology (CPT) is used to code the vast majority of medical operations carried out in a physician's office. These codes are updated yearly by the American Medical Association (AMA).
CPT codes are three-part groups of 5-digit numeric numbers. The most widely used category is the first, which is split into six groups. The following six important medical specialties are matched by these ranges:
CPT codes from the second category deal with performance evaluation and, occasionally, the findings of radiological or laboratory tests. These hyphenated five-digit alphanumeric numbers are frequently added to the end of Category-I CPT codes.
It is not permitted to use Category II codes in place of Category I codes; they are optional. The American Medical Association anticipates that Category II codes will lessen the administrative burden on doctors' offices by supplying ever-more precise information about the performance of healthcare providers and facilities. These codes are helpful for other doctors and health professionals.
The first category is probably the more prevalent one, but as a coder, you'll deal with the first two the bulk of the time.
The billing process is not complete without CPT codes. The procedures for which the healthcare provider wants to be reimbursed are described by CPT codes to the insurance payer. In order to give the payer a complete picture of the medical procedure, CPT codes collaborate with ICD codes.
The Healthcare Common Procedure Coding System (HCPCS), also known as “hick picks,” is a collection of codes based on CPT codes. The American Medical Association (AMA) maintains the HCPCS codes, which were developed by the Center for Medicare and Medicaid Studies (CMS). They mostly refer to items, processes, and services that CPT codes do not cover. Ambulance rides, durable medical equipment, prosthetics, and specific treatments and pharmaceuticals are all covered.
HCPCS is the recognized set of codes for Medicaid, Medicare, outpatient hospital care, chemotherapy medications, and other programs. HCPCS codes are among the most crucial ones a medical coder can employ because Medicaid and Medicare both use them.
Like CPT codes, each HCPCS code needs to be accompanied by a diagnostic code that describes the medical treatment. It is the responsibility of the coders to make sure that every outpatient operation stated in the medical report makes sense in light of the listed diagnosis, which is frequently identified by an ICD code.
Healthcare providers of various specializations can benefit from the high quality medical coding services provided by MF medical coding center. Our highly qualified staff of coding specialists has at least 7 years of expertise and is certified.
Send us an inquiry if you're interested in outsourcing MEDICAL CODING to MF, and we'll respond with the best possible solution.
