Medical Coding Guide


What Is Health Care Insurance Coding?medical-coding-guide

For every medical-related procedure there is a specific numeric code that matches it, whether the procedure is a symptom, injury, diagnosis, condition, disease, or medication prescribed. These numeric codes are used by medical billing professionals to prepare a formatted bill for a patient outlining the healthcare that was received, as well as for filing accurate reimbursement claims with the patient’s insurance company.

Miscoding for a procedure or a health condition can wreak havoc and result in a medical insurance company denying a valid and legitimate claim, a healthcare provider not receiving payment in a timely manner, unnecessary expenses charged to an individual, and can generally create a potentially stressful situation to undo.

In addition to understanding the coding languages, a health care insurance coding professional must have a deep wealth of knowledge about anatomy, physiology, disease treatment and medical terms, be skillful at analyzing data and problem solving, be detail-oriented and able to catch any discrepancies in a patient’s chart.

Medical Codes And Systemsmedical-codes-and-systems

There are currently three distinct medical coding systems that are being used by medical professionals: Current Procedural Terminology, or CPT, which is used by both hospitals and private practices, the Healthcare Common Procedure Coding System, or HCPCS, both Level I and Level II, which are used by Medicare and relate to medical supplies and equipment, and the third medical coding system, the International Classification of Diseases, or ICD, is used in conjunction with CPT medical codes to verify that specific medical services that an individual receives directly relates to an individual’s health condition.

An Explanation of Benefits is mailed to a patient after a medical bill has been sent and sometimes will list medical services provided by the numeric codes only and not explain what each code actually means in English. This is a disservice to the patient who deserves to understand what they are being billed for, and can make a person feel intimidated and disempowered.

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Three Different Medical Coding Systems With Examples:medical-coding-systems

  1. CPT codes were developed by The American Medical Association (AMA) and are used by physicians and hospitals to describe services, such as:
    • 99202 – Office visit for new patient, under 20 minutes
    • 36415 – Drawing blood
    • 86774 – Tetanus shot
  2. Level II HCPCS codes are used by Medicare to describe equipment and services that the CPT codes don’t include, such as:
    • V5060 – Hearing aid
    • D5110 – Dentures
    • E0110 – Crutches
  3. ICD-9 and -10 codes consist of diagnosis codes that are used in conjunction with CPT codes by The World Health Organization, such as:
    • 650.0 – Normal childbirth delivery
    • 301.0 – Paranoid personality
    • 783.0 – Anorexia

Benefits Of A Medical Coding Career:

  • A flexible schedule, able to work from home, low overhead
  • Short training time with online classes
  • High demand job with many opportunities
  • Health care field without the usual physical demands
  • Great pay

Medical Coding Benchmarksmedical-coding-benchmarks

Efficiency and accuracy are the ultimate goals of any medical coding professional and there are various degrees or levels of proficiency. How to establish productivity standards and improve on them?

Although medical insurance coders go thru a rigorous training to earn a professional certificate, once out in the field, a medical coder’s efficiency varies widely. This is dependent on a range of factors such as: the diverse work environments, the ease or difficulty of accessing a patient’s medical record and then deciphering a patient’s chart, and the ability to fully comprehend the complexity of clinical techniques and staying up to date with this knowledge.

Medical Coding References

Compare Hospitals: Individuals can compare medical procedures and see the average base cost versus the possible negotiated cost. It may be helpful to check with a medical billing advocate if a patient has reason to believe that the codes listed on his or her medical bill or Explanation of Benefits does not accurately reflect the medical services and equipment rendered. Use this site’s free trial period to research specific numeric medical codes.

American Medical Association: Find AMA / CPT codes.

Centers For Medicare & Medicaid Services: Find HCPCS codes.

Centers For Disease Control And Prevention: Find ICD-9 and ICD-10 codes.

Are you in need of medical coding assistance? Call us today at 866.254.1610 or fill out our contact form and we’ll contact you ASAP!