Medical coding is the process of assigning predetermined codes to identify and classify medical procedures and services rendered for patients by health care institutions and professionals. The purpose of translating patient records into code is to make it easy for insurance companies to determine the validity of claims filed with them for these procedures and services. Medical coders do the work of reading through the patients records and assigning the appropriate code to use for the services provided in the records. These coders use their own knowledge about coding, reinforced by classification manuals.
Once the correct code is determined it is inputted for that specific patient in their records. As mentioned, medical coding helps, not only to identify and classify the type of service that was rendered, but it also serves as an indicator of how much the specific claim to private or government owned insurance will be.
Among the many systems for medical coding are :
1. Current Procedure Terminology (CPT) – These procedure codes were developed and are today maintained by the American Medical Association. This set of codes are numeric and are used to describe sessions in physicians’ offices as well as outpatient procedures.
2. Healthcare Common Procedure Coding System(HCPCS) – Learning this set of codes is essential for working with Medicare or Medicaid. These codes are also kept by the American Medical Association and represent level 2 whereas the CPT codes represent level 1. Level 2 codes are alphanumeric and represent services, supplies and products not covered in level 1.
The importance of medical coding can be seen from the discussion above. Accuracy for the smallest detail is vital in a medical coder since the slightest mistake may result in the healthcare specialist’s claim being delayed.
Medical coding is also used for internal purposes in some establishments. They are used to easily evaluate the effectiveness of the services. Such evaluations are useful in arriving at the best procedures to apply to specific medical needs. Encoded patient records is also one way of gauging the performance of the health care specialists working for the institution.
They may also be useful statistics for determining which services may be in demand in a certain period of the year, or possibly also, what supplies and products are the most effective and therefore most prescribed for a certain ailment.
Such statistics as may be derived from medically coded records are useful not only for evaluation of services and personnel but also for planning out administrative matters, such as which department of the hospital is seeing the most use, or which health care specializations should be maintained and which should be discontinued altogether. Even in the matter of purchasing equipment, medical coding can allow the management of the institution to establish reorder levels for products and supplies that will make sure they are always available when needed.
While medical coding can still use a lot of improvement, especially regarding medical cases that are complicated and the differentiation of diagnoses that are similar but entirely the same, it is a considerably good move towards getting accurate medical statistics from a relatively large sampling of medical accounts over an extensive period of time.