Medical coders play a crucial role in the revenue cycle process, as they help ensure health systems, hospitals and physicians are properly reimbursed for the services they provide.
Here are 14 things to know about medical coding.
1. AAPC describes medical coding as “the transformation of healthcare diagnosis, procedures, medical services and equipment into universal medical alphanumeric codes.”
2. Once medical coding professionals assign a code to a specific healthcare service or procedure, the code is included on an insurance claim, according to AAPC. This code tells the insurer how much it owes for the care and helps determine how much the patient will be billed.
3. Coders use a number of classification systems when assigning codes, such as the Current Procedural Terminology, ICD-10 and the Healthcare Common Procedure Coding System Level II.
4. The first medical coding system, introduced by French physician and statistician Jacques Bertillon in the late 1800s, was known as Bertillon Classification of Causes of Death, reports The New York Times. The system was used to classify and track mortality.
5. Dr. Bertillon’s system was renamed the International Statistical Classification of Diseases, Injuries and Causes of Death in the 1940s, reports The New York Times. The U.S. previously used ICD-9 and currently uses ICD-10.
6. The transition from ICD-9 to ICD-10 represented a shift toward increased code specificity. ICD-9 has 3,824 procedure codes and 14,025 diagnosis codes, while ICD-10 has 71,924 procedure codes and 69,823 diagnosis codes.
7. More than one year after the ICD-10 go-live on Oct. 1, 2015, CMS ended the ICD-10 claims auditing and quality reporting leniency period. Guidelines now require providers to code to reflect clinical documentation in as much specificity as possible. Therefore, hospital and health system leaders must ensure both new and experienced coders are prepared to keep up with the coding requirements.
8. The Bureau of Labor and Statistics expects the job outlook for medical records health information technicians, or medical coders and billers, to grow 15 percent between 2014 and 2024. The average growth rate for all occupations is 7 percent during the same time period. Black Book Market Research projects the medical transcription, clinical documentation and coding market will grow by 12.9 percent from 2016 to 2020.
9. The roles of medical coders and billers, while complementary, are different. Medical coders review clinical documentation and designate standard codes using the ICD-10 classifications. Medical billers process and make sure claims for services administered by providers are sent to payers for reimbursement.
10. Accurate coding of claims requires correct clinical documentation. Coders are unable to assign proper codes when documentation is incorrect or lacking, which could result in a claim being rejected by an insurer.
11. In 2016, the average annual salary for medical coders/billers in health systems was $52,320, while medical coders/billers in large group practices had an average salary of $49,452, according to AAPC.
12. Medical coders don’t have to have bachelor’s or master’s degrees, but they must be well-versed when it comes to anatomy, physiology and medical terminology education, according to AAPC.
13. Coding for inpatient records saw the greatest decline in productivity in 2016, followed by clinical documentation in the outpatient and emergency department settings, according to himagine’s 2016 HIM Benchmark Report.
14. Adrienne Younger, RN, certified clinical documentation specialist manager of clinical documentation improvement education at Nashville, Tenn.-based Ardent Health Services, offered the following coding advice for hospitals: “Collaborate with your coders. Coding is such a unique profession. I think historically coders have been left on their own. But I think by providing coders with resources to better understand what it is they are coding and to help them understand the clinical side of it, they become more vested in what they do. They’re not just there to code a record. They’re actually looking out for the patient outcome. They’re identifying things they may not have identified before because now they think it needs to be brought to the attention of somebody else on the team. So collaborate with them and make them feel like they are part of the entire hospital system team.”
Photo courtesy of: Becker’s Healthcare
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