What is Medical Coding?
Shyam Sunder , 14-Oct-2023
Clinical coding is the translation of narrative healthcare information including symptoms, signs, diagnosis, services, procedures, drugs, supplies, consumables and durable medical equipment (DME) into standardized clinical alphanumeric information.
Why is Medical coding needed:
The documentation of patient information including diagnoses and procedures is a mandatory process as part of regulatory and accreditation requirement. 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. 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 tracked, analyzed and understood.
Applications of Medical Coding:
The usage of standardized codes helps healthcare organizations to analyze patient information in a better way.
Reimbursement Process: Healthcare providers submit the codes to the payers to claim reimbursement fees.
Monitor medical services: Coded data is used by medical facilities to focus on quality of care and monitoring utilization of services.
Healthcare Research: Medical codes are important in research because they allow researchers to easily track certain diseases and conditions.
Regulatory requirement: Clinical coding using standardized codes is mandatory process In some countries like USA, UAE, Australia, etc.
Accreditation requirement: The Joint Commission (TJC) recommends using standardized codes to provide accreditation to healthcare facilities.
Types of Codes Used:
Medical coding is performed all over the world, with most countries using different types of coding systems.
In the United States, there are six official HIPAA-mandated code sets serving different needs.
ICD-10-CM: International Classification of Diseases (ICD) is maintained by the World Health Organization and modified by each member country to serve its needs. ICD-10-CM is a modified version used in USA. There are approximately 72000 in ICD-10-CM for coding symptoms, signs, diagnoses, Poisoning, injuries, cause of injury, etc.
CPT: This code set, owned and maintained by the American Medical Association, includes more than 8,000 five-character alphanumeric codes describing services provided to patients by physicians, paraprofessionals, therapists, and others.
ICD-10-PCS: It is a 130,000 alphanumeric code set used by hospitals to describe surgical procedures performed in operating, emergency department, and other settings.
HCPCS Level II: These are 7,000-plus alphanumeric codes are used for those procedures for which no code is available in CPT.
CDT: These are codes are owned and maintained by the American Dental Association (ADA). The five-character codes start with the letter D. Most dental and oral procedures are billed using CDT® codes.
NDC: The Federal Drug Administration's (FDA) code set is used to track and report all packages of drugs. The 10-13 alphanumeric character smart codes allow providers, suppliers, and federal agencies to identify drugs prescribed, sold, and used.
MS DRG: These are reported by a hospital to be reimbursed for a patient’s stay. The MS-DRG is based on the ICD-10-CM and ICD-10-PCS codes reported. They are defined by a particular set of patient attributes which include principal diagnosis, specific secondary diagnoses, procedures, sex, and discharge status. The Centers for Medicare & Medicaid Services (CMS) work with 3M HIS to maintain this data set.
APC: These are maintained by the Centers for Medicare & Medicaid Services (CMS) to support the Hospital Outpatient Prospective Payment System (OPPS). Some outpatient services in a hospital, such as minor surgery and other treatments, are reimbursed through this system.
