The Performance of Medical Coding
What responsibilities are required in Medical Coding? How is Medical Coding beneficial in the healthcare industry? Herzing University (2009) says, “Medical Coding is the act of billing patients and health insurances for the medical checkup they received.” Medical Coding is one of the most valuable careers in the Healthcare industry. However, this profession requires important guidelines, such as assigning proper health-related codes, understanding coding language, and meeting the terms of the compliance rule. Moreover, as a productive benefit in this line of work, many employers allow medical coders to enter codes from home.
The first rule that applies to Medical Coding is the importance of code assignments. After a patient is seen by a physician in an office or hospital room, the medical coder’s job is to assign the appropriate health diagnosis code on the claim form. The claim form is to be submitted to the patients’ insurance company for reimbursement purposes; claims are submitted to insurance companies so that doctors will be paid for the services rendered in the office as well. Upon submitting the claim form(s), it is important for the medical coder to assign the correct code(s) to ensure a timely payment process. If the code(s) are incorrect, this will cause the claim to be denied and payment will not be released until the issue is corrected. Herzing University (2009) comments that “Every medical diagnosis or procedure that is done in a medical office should have a health-related code assigned to it. The medical coder is accountable for assigning the correct code for each procedure that is performed on a patient.” In addition, AHIMA (2009) predicts that “the excellence of medical services depend on if a medical coder assigns codes accurately and in a timely fashion.”
In Medical Coding, the first and foremost responsibility is to make certain that the payment reviews and funds flow effectively. Scichilone (2008) also points out that “the timely completion of assigned codes depends on the accuracy of the coding process.” Therefore, assigning proper codes for medical procedures are essential because it will guarantee timely payment to medical providers and their patients’.
Another rule that applies to Medical Coding is the understanding of coding language. Where does the resource of coding come from? Who maintains the health-related coding system? The American Health Information Management Association (2009) clarifies that “the resources for the health-related coding are maintained by a particular group of organizations. These groups are responsible for the updates and or changes for the coding process. The National Center for Health Services, is in charge of the ICD-9-CM codes, whereas, The American Medical Association is responsible for the CPT codes.” What is the coding language and why is it used in Medical Coding? In Medical Coding, an ICD-9-CM code is entered on a claim to code a patient”s diagnosis received from the physician. In addition, there may be more than one diagnostic code on a claim form. A CPT code is entered on a claim to code a procedure that was performed on the patient(s). There may be more that one procedure code entered on the claim form as well. For simplicity principle, the codes assigned convey what types of service(s) were provided and why the procedure was done. Rogoski (2004) adds that “[t]here are two major coding [organizations that are responsible for the coding language],..: the ICD-9-CM diagnosis and procedure codes that are maintained by the federal government, and the CPT procedure codes that are maintained by the American Medical Association.”
For verification purposes, American Medical Association (2009) define the definition of the diagnosis code ICD-9-CM is “The International Classification of Diseases, Ninth Revision, Clinical Modification,” while (CDC, 2009) notes that the CPT procedure code means “Current Procedural Terminology.”
The most important rule that applies to Medical Coding is the consistency of data entries. Being that coding information is updated on a quarterly and yearly basis by the health care organizations, it is important for the medical coder to enter the updated or revised codes accordingly. Entering the correct diagnosis and procedure code(s) is essential because the code(s) determine how and why reimbursement or payment is requested. During the coding process, it is imperative for the coder to obtain the up-to-date information on medical services covered by the patients’ insurance company to avoid questionable outcomes. In other words, the services that are covered under a carrier should match what is documented in the compliance guidelines and if the coding or documentation is not consistent with the specific guidelines, this can develop into an investigation and claim rejections. AHIMA (2009) contends that, “Entering the appropriate data according to the compliance rule is very important in the coding process. Whether the codes are entered correctly or not, it will in one way or another, affect both the quality of the statistics and the fulfillment to the regulations.” For that reason, to stay current with the array of coding rules, the Medical Coder should always consult with the healthcare guidelines upon entering the code(s) on a claim form ensure the quality of medical information.
Furthermore, to ensure data consistency according to the compliance rule, meticulous medical coding software has been utilized to assist the medical coders during the coding process. “Computer-Assistance Coding” is how (Scichilone, 2009) describes the software. Even though coding can be complicated especially when trying to remember and stay up to date with guidelines, the use of medical coding software will promote thorough and affirmative results. Scichilone (2009) explains that “[t]hose little numbers or alpha-numeric [series] are one of the reasons the compliance [organization] exists.” The coding process is to note what type of medical service was provided and the reason for the office visit. To acquire efficiency, new software has been executed to help providers concerning data consistency guidelines. Medical coders can use this specific computer software to produce organized health codes for evaluation.” Not only does this medical coding software assist in positive reviews from the compliance group, it encourages moral standards as well.
As an added guideline precaution, healthcare providers are should distribute the compliance rule list within its facilities to ensure proper and precise coding. The list should include a detailed medical coding policy that must be adhered by accordingly. One author (Stegman, 2009) notes that “[f]or many clinical areas with commonly provided services, very specific coding and billing guidelines exist to assist the provider in reporting accurate and honest claims… Ideally, the provider should have a coding compliance policy document with…the following [factors]…”
- Instructions on how to assign codes for new medical procedures;
- Instructions on how to correct inaccurate codes that were previously assigned;
- Code of conduct requirements linked to the Healthcare service provided,
- Annual or semi-annual training in Healthcare compliance guiding principles,
- Disciplinary steps taken if failure to comply with the guidelines occur, and
- Helpful contact phone number to seek out additional or unclear information.
In the Medical Coding position, these issues should provide helpful healthcare solutions when it comes to assigning medical codes for claim submission. By following these procedures, this will develop data quality within the healthcare environment because of the consistency assignment entries. Stegman (2008) agrees with these methods by saying that “coding experts are likely to sustain the importance of accurate and consistent coding traditions to deliver quality health care …Medical coders should continue to improve their coding skills to stay current with the coding regulations
The Medical Coder must maintain and follow the coding guidelines to avoid improper results with insurance companies and patients. If these compliance guidelines are not available by the provider, the medical coder(s) may have a difficult time assigning consistent codes. Stegman (2008) points out that “[w]hen coding challenges arise,… and unresolved documentation inconsistencies are present, the selection of the most accurate and compliant codes may be more difficult, particularly if the coding…staff are not aware of the [moral coding standards].” If the preceding coding process for Medical Coding is carried out appropriately according to the compliance guidelines, this will ensure data excellence.
Finally, while Medical Coding maintains specific guidelines to ensure effective results in the healthcare industry, many people are pursuing this type of work to take advantage of the flexible productive benefits. Many employers are allowing Medical Coding to be managed from home. To ensure that a Medical Coder generates efficient productivity from home, the “Computer-Assistance Coding” medical software that (Scichilone, 2009) described earlier, would be a very beneficial technology tool in the healthcare industry. Many health providers are providing its medical coders to work from home; working flexible hours and increase productivity are a couple of reasons why working from home is available. Flexible productivity (2004) states that “many healthcare corporations are engrossed with the productive benefits of flexibility working from home. By minimizing the demand of office space and reducing commuting time, the medical coder will gain flexible productive time and possibly get to manage their work-life obligations.” While the Medical Coder manages the medical software that was provided by their employer, on their home computer, the programmed software will generate assignment codes that are consistent with the compliance regulations. Scichilone (2009) says that the coding software will “increase… productivity in code assignment [, provide] consistent application of reporting rules and guidelines [,] and …monitor…[the] evaluation features for coding accuracy reviews.” Consequently, utilizing the coding software will provide added advantages in Medical Coding.
In conclusion, since Medical Coding requires specific guidelines for the healthcare industry to follow, it is imperative to abide by the compliance rules to avoid poor data standards. By entering accurate and thorough health-related data into the medical database, and obtaining a clear understanding of coding language and their resources, this cause of action will help the flow of the reimbursement process run effectively; as an added advantage, Medical Coding can be accomplished in the comfort of the medical coders’ home by way of compliance-ready medical software.
- AHIMA About Medical Coding & Medical Records: (2009). Coding. Retrieved November 26, 2009 from http://www.ahima.org/coding/index.asp
- AHIMA Medical Coding Guidelines:Data Quality and Compliance (2009). . Retrieved December 9 2009 from http://www.ahima.org/coding/compliance.asp
- AHIMA Medical Coding Resources (2009). Coding Resources. Retrieved December 7, 2009 from http://www.ahima.org/coding/coding_resources.asp
- AMA – CPT Code Information and Education (2009). American medical association. Retrieved November 28, 2009 from http://www.ama-assn.org/ama/no-index/physician-resources/3884.shtml
- CDC – ICD-9-CM International Classification of Diseases, Ninth Revision, Clinical Modification (2009). Centers for disease control and prevention. Retrieved November 26, 2009 from http://www.cdc.gov/nchs/icd/icd9cm.htm
- Flexible productivity.(2004). International Journal of Productivity and Performance Management,53(5/6),476-477. Retrieved November 30, 2009, from ABI/INFORM Global. (Document ID:695572871).
- Medical Billing and Insurance Coding Overview (2009). Herzing university online. Retrieved November 23, 2009 from http://www.herzingonline.edu/programs/medical-billing-and-insurance-coding
- Richard R Rogoski. (2004,September). If You’re Not Coding, You’re Not Billing.Health Management Technology,25(9),14, 16, 18. Retrieved December 7, 2009, from ABI/INFORM Complete. (Document ID:687678731).
- Scichilone,R.(2009,July). Are We There Yet? Compliance-Ready Computer-Assisted Coding.Journal of Health Care Compliance,11(4),55-56,69-70. Retrieved December 7, 2009, from ABI/INFORM Global. (Document ID:1822883141).
- Scichilone,R.(2008,July). Enhanced Compliance Results by Improving the Code Assignment Process.Journal of Health Care Compliance,10(4),61-64. Retrieved December 5, 2009, from ABI/INFORM Global. (Document ID:1670291831).
- Stegman,M..(2009,September). Managing Billing Interpretations in a Compliance Environment.Journal of Health Care Compliance,11(5),65-66,77-78. Retrieved December 7, 2009, from ABI/INFORM Global. (Document ID:1882772921).