Medical Coding Blog 

Let's begin with a basic medical coding question: We code medical reports for a variety of reasons. Isn't it enough to just write down the symptoms, diagnosis, and procedures, send them to an insurance provider, and wait to hear which services are covered?

 

When you visit the doctor with a sore throat, fever, or enlarged lymph nodes, what happens? The doctor will only officially submit his diagnosis in a simple case like this, but it will still include a diagnosis, a procedure, and a prescription.

 

Medical coding facilitates the delivery of large amounts of data to insurance companies. According to the CDC, over 1.4 billion patient visits were made in the previous year. If each visit contained only five pieces of coded information, there would be 6 billion distinct pieces of data to transport each year.

 

With standardised data, government and health institutions may conduct more efficient research and analysis to track health trends. Coding also makes it possible to have consistent documentation throughout medical facilities. If the CDC wants to look into the prevalence of viral pneumonia, they can use the ICD-10-CM code to look up the number of recent pneumonia diagnoses.

 

Three Primary Medical Codes:

ICD-10

As a medical coder, you'll use three sets of codes on a daily basis. ICD codes, or International Classification of Diseases, are used to represent a doctor's diagnosis and the condition of a patient. The National Center for Health Statistics has implemented a set of changes known as Clinical Modification. Coders must ensure that the procedure they're billing for is compatible with the diagnosis.

 

CPT

The American Medical Association (AMA) publishes and maintains the CPT codes. They're three-category five-digit numeric codes. The first, which is separated into six ranges, is the most commonly utilised. Performance evaluation and, in some situations, laboratory or radiological test findings fall under the second category. Emerging medical technology is the subject of the third category of CPT codes.

 

HCPCS

HCPCS codes are used to describe services, procedures, and equipment that are not covered by CPT codes. Durable medical equipment, prostheses, ambulance journeys, and specific treatments and medicines are all examples of this. Each HCPCS code should be paired with a diagnostic code that explains why the medical operation was performed. It is the job of the coders to ensure that whatever outpatient procedure is described in the doctor's report is correct.

 

Now that you have a better understanding of what each of these codes is and what they accomplish, let's go further into each code set.

I hope you enjoy reading this blog post.