Medical coding plays a significant role in overall revenue cycle management. It is absolutely necessary to get paid for all services rendered by healthcare providers. Medical coding process is complex and requires certified professionals to handle it to ensure efficiency and accuracy. Certified medical coders bring in lot of assurance to the entire coding process.
In order for a person to become a certified coder, they need to undergo various training including:
• Medical Terminology
• Anatomy and Physiology
• ICD-9-CM & ICD-10-CM
• CPT procedural Coding
• HCPCS coding
• General HIPAA (Health Insurance Portability and Accountability Act), which governs the privacy, confidentiality and reporting laws related to medical information.
Certified coders need to clearly understand how to use the following code sets:
• 1. ICD-9-CM (International Classification of Diseases): Diagnoses or medical conditions are represented by three to five digit numeric or alpha-numeric codes.
• 2. CPT (Current Procedural Terminology): Medical services or procedures are represented by five-digit numeric codes.
• 3. HCPCS (Healthcare Common Procedural Coding System): Five-digit alphanumeric codes used to describe medical supplies and drugs.
Responsibilities of Medical Coders:
• Review the medical reports
• Locate the services rendered to the patient and select the proper CPT code for reporting those services to the insurance company.
• Locate the associated diagnoses for which services were rendered and select the proper ICD-9-CM/ICD-10-CM diagnosis code for reporting to the insurance company.
• Indicate these codes on the super bill or charge sheet or in the billing software directly
• Keep up to date on any changes to the code sets used to report services and diagnoses.
• Keep up to date on any new advances in medical procedures or newly discovered diagnoses that have come to pass and if associated with the practice or facility you work with, research to find the correct codes to use for reporting.