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Understanding Medical Coding

In the United States, a physician typically examines you and may administer a treatment before your insurance pays for the services, writes Anne B. Casto, RHIA, CCS, program manager for the Health Information System at Ohio State University. Medical coding represents the list of numerical codes that your health insurance and your doctor use to designate accurately and document rapidly your illness as well as the medical service rendered to you.

  1. Significance

    • Although this code appears on the health insurance claim forms that your doctor's office fills out for each one of your visits, this information typically remains invisible to you. However, your physician pays great attention to medical coding as each code represents income to him in the form of a reimbursement from the health insurances, explains the American Academy of Professional Coders.

    Value

    • The efficiency of using one symbol to represent what the physician did during your visit clarifies the dialog between the insurances and your doctor and accelerates the payment to your physician. On a broader scale, this coding allows to monitor with computers the incidence and spread of diseases in the United States, according to Fu-Chiang Tsui, Ph.D, affiliated with the Center for Biomedical Informatics at the University of Pittsburgh. Health insurances can search diagnoses by codes and detect epidemic outbreaks.

    Mandate

    • Medical coding, first used on a volunteer basis, became mandatory in 1996 with the deployment of the Health Insurance Portability and Accountability Act of 1996 (HIPAA). HIPAA requires that all patient information remains private. As a result, patients' conditions and treatments are systematically coded in all the patient documentations to create a shield of privacy.

    Most Frequent Medical Codes

    • The Healthcare Common Procedure Coding System represents an umbrella for two medical coding methodologies. The Current Procedural Terminology (CPT) system, managed by the American Medical Association, covers most of the outpatient activities run in a physician's office. The US Centers for Medicare and Medicaid Services sets the codes for non-physician services such as ambulance interventions and supplies.

    Coding for Hospital Care

    • If you spend a few days in the hospital, your treatment most likely will fall under the Diagnosis-Related Group (DRG) coding system. The DRG represents an amount of funds, estimated from national statistics, authorized by the insurances to cover the cost of caring for the disease independent of the length of hospital stay and the procedures or therapies selected. This system covers about 500 different medical conditions and their associated treatments and uses the International Classification of Diseases (ICD) as the foundation for its coding.

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