Medical coding is important in hospitals, medical offices and other facilities to relate information to insurance companies regarding procedures a patient receives and the medical reasons for the treatment. The Health Insurance Portability and Accountability Act of 1996 (HIPAA) stipulates the standards for medical coding. Some medical officers provide training in medical coding, but most medical coders receive an associate's degree from an accredited college followed by a certification.
Terminology
Medical terminology is an important part of medical coding. A medical coder is required to have knowledge of medical terminology, such as the term "anterior," which is defined as the front, when reviewing charts to code. Another example of medical terminology includes the term "radius," or forearm. Medical terminology allows a coder to determine which procedures were performed and which diagnosis denotes medical necessity.
Procedure Codes
Physicians and medical staff members perform procedures on patients. The American Medical Association (AMA) has a standard for billing the procedures performed by using the Current Procedural Terminology (CPT) manual. Medical coding consists of matching the procedures performed with the five digit CPT codes. Several procedures may be listed on a claim form but each must be dated to indicate when it was actually performed.
Diagnosis Codes
The International Classification of Diseases (ICD) code is used in conjunction with CPT codes to relay for billing purposes the diagnosis, or symptom, used to denote medical necessity for the procedures. Diagnosis codes may be used multiple times and matched with several procedure codes on a claim form. They consist of three numbers and may be followed by up to two decimal places. An example of an ICD code is 320, which represents bacterial meningitis.
Nonmedical Codes
The Health Care Common Procedure System (HCPCS) is a system used to code nonmedical services and supplies. The Centers for Medicare and Medicaid Services (CMS) provides this coding system. Orthotics or wheelchairs are examples of items under this coding.
Using Modifiers
Medical coding requires the use of modifiers in some instances. Insurance companies use modifiers to obtain more precise information on a procedure performed. For example, if a patient has an X-ray done on his left wrist, an "LT" is added beside the procedure code to represent left.
Tags: claim form, medical necessity, procedures performed, this coding