Why is coding important in healthcare

With suboptimal reimbursement, it is difficult for them to provide stellar healthcare to patients. While it also pertains to the all-important aspect of insurance reimbursement, medical coding differs in that it involves a unique code for each diagnosis and medical procedure.

The translation of diagnoses and procedures into these universal codes allows the health care provider to process the bill correctly. Created by the World Health Organization WHO , the ICD and its contents are important not only for maintaining records and billing, but also allows for data to be kept on diseases both domestically and worldwide. To this point, it is pretty clear that medical billing and coding are imperative processes to the upkeep of hospitals and medical offices.

Medical facilities rely heavily on insurance providers and other healthcare programs for funding. Insurance companies make their profit by charging those who hold policies monthly fees, or premiums. The buy-ins from the individuals in the pool allows the insurance providers to cover the bulk of medical costs of policyholders, depending on the policy.

That is why it is vitally important for medical billing and coding to be done, and done accurately. Every patient who visits a hospital, immediate care center or other medical facility has information that needs to be documented.

It is not uncommon for hospitals and medical offices to employ one person or persons who are knowledgeable about both medical billing and coding. Community colleges, trade schools and online education options frequently teach these two skills together in training programs, given the overlap of importance to each other.

Its extensive training provides students with the skills needed for a successful career in an inpatient or outpatient setting.

The program partners with the AAPC American Academy of Professional Coders to provide instruction in anatomy, physiology, medical office management, coding protocols and medical terminology.

The program offers preparation for three different certification exams. Request information to learn more about how SOCHi can prepare you for an exciting and fulfilling career in medical billing and coding.

As our students grow and learn to discover their abilities at SOCHi, so does our curriculum! Our curriculum is adapting and growing to accommodate our diverse student body. Stay tuned to see how SOCHi is growing to assist you on your journey to success! Like a musician who interprets the written music and uses their instrument to produce what's intended, Medical Coding requires the ability to understand anatomy, physiology, and details of the services, and the rules and regulations of the payers to succeed.

Medical coding derives from public bills of mortality posted in London in the 18th century. It was through correlating these that doctors determined the cause of a cholera epidemic. It is even more vital now as the data gathered through Medical Coding is used to improve healthcare overall.

The results are submitted to payers for reimbursement, but the data derived from the codes also are used to determine utilization, manage risk, identify resource use, build actuarial tables, and support public health and actions. The Medical Coder and biller process a variety of services and claims on a daily basis.

Medical codes must tell the whole story of the patient's encounter with the physician and must be as specific as possible in capturing reimbursement for rendered services. To better understand what a coding transaction looks like, read the article " What Does a Medical Coder Do?

Medical billers, on the other hand, process and follow up on claims sent to health insurance companies for reimbursement of services rendered by a healthcare provider. The Medical Coder and medical biller may be the same person or may work with each other to ensure invoices are paid properly. Both work together to avoid insurance payment denials. The healthcare revenue stream is based on the documentation of what was learned, decided, and performed.

A patient's diagnosis, test results, and treatment must be documented, not only for reimbursement but to guarantee high quality care in future visits. A patient's personal health information follows them through subsequent complaints and treatments, and they must be easily understood.

This is especially important considering the hundreds of millions of visits, procedures, and hospitalizations annually in the United States. The challenge, however, is that there are thousands of conditions, diseases, injuries, and causes of death.

There are also thousands of services performed by providers and an equal number of injectable drugs and supplies to be tracked. Medical coding classifies these for easier reporting and tracking. And in healthcare, there are multiple descriptions, acronyms, names, and eponyms for each disease, procedure, and tool. Medical coding standardizes the language and presentation of all these elements so they can be more easily understood, tracked, and modified.

Nearly all private health information is kept digitally and rests on the codes being assigned. Medical coding is performed all over the world, with most countries using the International Classification of Diseases ICD. ICD is maintained by the World Health Organization and modified by each member country to serve its needs.

ICDCM includes codes for anything that can make you sick, hurt you, or kill you. The 69,code set is made up of codes for conditions and disease, poisons, neoplasms, injuries, causes of injuries, and activities being performed when the injuries were incurred. ICDCM is used to establish medical necessity for services and for tracking. This code set, owned and maintained by the American Medical Association, includes more than 8, five-character alphanumeric codes describing services provided to patients by physicians, paraprofessionals, therapists, and others.

Physicians also use it to report services they perform in inpatient facilities. In the billing process, these codes are used to determine medical necessity. Coders must make sure the procedure they are billing for makes sense with the diagnosis given. To return to our strep throat example, if a coder listed a strep throat diagnosis as the medical justification for an x-ray, that claim would likely be rejected.

These codes are copyrighted by the AMA and are updated annually. CPT codes are five-digit numeric codes that are divided into three categories. The first category is used most often, and it is divided into six ranges. These ranges correspond to six major medical fields: Evaluation and Management, Anesthesia, Surgery, Radiology, Pathology and Laboratory, and Medicine.

The second category of CPT codes corresponds to performance measurement and, in some cases, laboratory or radiology test results. These five-digit, alphanumeric codes are typically added to the end of a Category I CPT code with a hyphen.