Introduction

As technology became more reliant in the healthcare industry, medical coding has developed into a crucial part of it. Medical practitioners as well as insurance companies have grown contingent to medical coding with each passing improvement.

The coding process originated in the 17th century England has today advanced into a systematic procedure in the industry.

What is Medical Coding?

Medical coding principally translates healthcare record, diagnosis, reports, medical services and systems into specific alphanumeric codes.

It is centrally the process of translating extensive medical data and services into efficient and uncomplicated codes. Daily, numerous patients visit the hospital, and with each visit the data multiplies several folds, making it a lengthy process for medical practitioners to evaluate.

Medical coding helps in the assessment of records by generating appropriate codes and labels mitigating the daily burden of billers and coders. It is essential for medical coders to translate and update the codes correctly to make the billing procedure free of any errors.

These codes, later on, help in claiming reimbursements during billing by the hospitals which benefits both the patient and the doctor. Therefore, due to the recent overhaul in the industry, every hospital is in acute need of a medical coder.

Medical Coders- The new foundation in Healthcare

Translating all the patient records into codes is not an easy job in healthcare. A certified Medical coder must work well with numbers, computer systems, and various software programs. He can work in hospitals, clinics, urgent care facilities, nursing homes, treatment centers, etc.

The coder first takes the medical charts and records from the doctors and read the patients’ reports. After reading and understanding the procedures, they assign codes, feed data in the computer and finally translate the records for an enhanced coding and billing system. It is important to decipher the data accurately as any change in a minuscule code can result in an erroneous judgment during a medical procedure.

A medical coder plays a vital role in the reimbursement process. After giving required services to a patient, medical practitioners or hospitals need to be reimbursed by the insurance companies. The codes of services and facilities provided by medical coders help the doctors claim their reimbursements.

Why is medical coding the next best thing?

With each patient visit, there exist at least 2-3 set of records and documentation. These records can get as descriptive as the visits increase. And to decode such intricate reports, certified medical coders are a must.

In the years to come, the rate of hospital visits will cross over 6 billion visits a year which directly indicates a hike in the proportion of patient data. These complex data need to be converted into simple terms for medical practitioners, billers and insurance companies to understand. Medical coding helps the practitioners to follow the previous visit’s data. It includes the necessary treatment, kinds of symptoms a patient has or any other detailed analysis helpful in the diagnosis of a patient.

These codes make communication with the doctor easy by providing the documentation and comprehensive patient data into an easy to understand the coding system.

Commercial payers like insurance companies, Medicare and Medicaid use these codes while paying a claim.

It is indispensable to submit and communicate appropriate codes because these organizations can even refuse to pay if these codes are in any way inappropriate or erroneous. The common language is too vague for the insurance companies to know what type of reimbursement they have to pay.

The coding and billing system helps the companies segment their payment options easily. The insurance companies use these codes in eliminating the fraudulent claims or any other errors in payments.

Big changes ahead in medical coding

CMS administrator, Seema Verma, in the proposed rule has manifested the patient over paperwork initiative. The recent changes in the various codes and modifiers only corroborate with what the CMS’s agenda was.

1. E/M changes

a- The key change made in the E/M visits is the use of time basis or the decision making capability of the practitioner rather than the 1995 or 1997 guidelines. This change has made the E/M visits less papery and strenuous for the coders.



b- E/M codes are part of the CPT codes which holds a prominent position while translating the records in the codes.

2. Additions in CPT codes



a- From 1st, January 2019 the new CPT (Current Procedural Terminology) codes have come into effect. CMS has deleted 72 codes, added 164 new codes and revised 49 codes in the latest rule.



b- Category II codes, under surgery –Integumentary, Pathology and the Medicine section has testified the highest revisions in the updated codes.



c- In the 2019 updates, CPTs 99446, 99447, 99448 and 99449 are now covered for Medicare patients.



3. Latest ICD-10 CM revisions



a- ICD-10 CM codes are effective from October 1, 2018, through September 31, 2019, with various revisions, additions, and deletions.



b- The latest updates include 279 new codes, 51 deleted codes, and 143 revised codes. A total of 71,932 active codes have been recorded with the most recent CMS revisions.



c- Chapters 1, 3 and 8 witnessed no new changes whereas chapter 2,7,11,14,15,16 and 19 went through the highest changes.



4. HCPCS codes overhaul



a- CMS has also changed HCPCS codes Q9994, effective December 3, 2018.



b- The HCPCS code B4105 is changed from D “Special Coverage Instructions Apply” to C “Contractor Discretion. Code B4105 replaces code Q9994 effective for claims with dates of service on or after January 1, 2019.



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