Medical Coder's Job

Medical Coding – What is it?

Medical Coding is very closely tied into the process of Medical Billing. Medical Coding is an important facet in the Healthcare Industry.

In simple terms, coders transform the descriptions of diseases, injuries and healthcare procedures and services provided by doctors into alphanumeric codes. These codes are universally accepted and recognized.

So why do we need to translate these diagnoses and procedures into codes?

Why don’t we just let the medical charts tell the whole story. That’s a very good question. But we need to step back and analyze the whole US Healthcare scenario. Insurance payers need to reimburse the doctors for their services. There are billions of patient visits each year. If the insurance payers would need to sift through billions of charts for payment purposes, they would get back logged and the doctors may not see payments for months. It is simply not logical. Whereas if you just translate the medical diagnoses and medical procedures into codes, this brings down the amount of information generated and also explicitly explains the doctor-patient encounter.

Also using uniform codes accepted by all is really needed to study the disease trends and the effectiveness of treatment and vaccines. WHO keeps a track of health of the world populations and uses the ICD codes to study them. ICD codes are universally accepted.

ICD codes are used to represent a doctor’s diagnosis and the patient’s condition.

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Vascular Catheterization - Coding

Vascular system anatomy and terminology to make reporting these procedures less challenging. A thorough understanding of the anatomy and medical terminology of the vascular system is required to accurately code arterial vessel procedures. Here’s a quick run-through of clinical information and coding guidance to show you how order affects coding. Order Matters Please refer to Appendix L of the CPT® code book for the vascular families. The aorta is the major artery. Each main vessel branching off the aorta is a first order vessel (e.g., left common carotid). First order vessels have several vessels branching off them, designated as second order vessels (e.g., right subclavian and axillary). Second order vessels have several vessels branching off them, designated as third order vessels (e.g., right internal carotid). Third order vessels have several smaller vessels branching off them, designated as beyond the third order (e.g., left deep palmar arch). Catheterization Can Ei...

Place Holder X

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Injections & Infusions Coding

Here are the three basic coding rules that you must adhere to when billing for Injection/Infusion services: Rule #1: Pay Attention to the Administration Route When you’re looking at the treatment note, you can first look for hints to proper coding by identifying the Route of Administration. the Injection/Infusion CPT® codes fall into one of three major categories: 1. Intravenous Infusions (IV) 2. Intravenous Pushes (IP) 3. Injections (Sub-Q, IM) Don’t forget: The Centers for Medicare & Medicaid Services (CMS) regulations look at the way a drug is administered only as “the physical process by which the drug enters the patient’s body” – not whether a medical professional administers the drug or supervises the administration. But the administration route hierarchy isn’t the only one you need to understand for Injection/Infusion coding — there is another hierarchy for the type of agent that works in tandem with the administration one. Rule #2: Unde...

Burns and Corrosions

Chemicals, such as lye or acid, can cause corrosion upon contact with a person's skin. As a professional coding specialist, you may need to code the diagnosis of a burn or corrosion. A chemical burn occurs when living tissue is exposed to a corrosive substance such as a strong acid or base. Chemical burns follow standard burn classification and may cause extensive tissue damage. Burns from a heat source are classified by depth (first, second, third, unspecified), extent, and agent. For multiple burns, sequence the highest degree burn first. Multiple burns of the same three-character category are coded to the highest degree. Non-healing burns are coded as acute burns. The extent of injury is best described using the percentage of the total body surface area (%TBSA) that is affected by a burn. The measurement of burn surface area is important during the initial management of people with burns for estimating fluid requirements and determining need for transfer to a burns service T...

Systemic vs. Pulmonary Circulation

What Does the Heart Do? The heart is a pump, usually beating about 60 to 100 times per minute. With each heartbeat, the heart sends blood throughout our bodies, carrying oxygen to every cell. After delivering the oxygen, the blood returns to the heart. The heart then sends the blood to the lungs to pick up more oxygen. This cycle repeats over and over again. What Does the Circulatory System Do? The circulatory system is made up of blood vessels that carry blood away from and towards the heart. Arteries carry blood away from the heart and veins carry blood back to the heart. The circulatory system carries oxygen, nutrients, and hormones to cells, and removes waste products, like carbon dioxide. These roadways travel in one direction only, to keep things going where they should. What Are the Parts of the Heart? The heart has four chambers — two on top and two on bottom: · ...

CPT Quiz - 40000 Series

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Combination Codes

It’s one of the most important questions coders must ask while using ICD-10: Is there a single combination code that fully identifies the patient’s relevant conditions, or is it necessary to report two separate codes? The volume of combination codes in ICD-10 has increased, making it imperative for coders to be alert and aware of instances in which combination codes are applicable. Defining Combination Codes The ICD-10-CM Official Guidelines for Coding and Reporting describe combination codes as those used to classify the following: • Two diagnoses • A diagnosis with an associated secondary process (manifestation) • A diagnosis with an associated complication Coders cannot — and should not — assign multiple diagnosis codes when a single combination code clearly identifies all aspects of the patient’s diagnosis. For example, say a pati...

ICD-11

After the tumultuous transition to the 10th International Classification of Diseases, simply saying the phrase “ICD-11″ is liable to strike fear in the hearts of medical providers across the country. But the inevitable truth is that ICD-11 is looming large on the healthcare horizon, and physicians who are unprepared for this transition will see an uptick in rejected claims and a drop in reimbursements—so preparation is key. In this article, we’ll go over a detailed timeline to help you create deadlines for yourself and pace out your own transition from ICD-10 to ICD-11, all while avoiding complicated diagnostic issues that could impact your revenue cycle. What is ICD-11? ICD-11 is the newest iteration of the International Classification of Diseases scheduled to take effect in January 2022. As you probably already know, ICD-10 was introduced way back in 1992, and it took the U.S. 23 years to completely transition to it. So after only having completed that arduous ...

Allograft vs Autograft vs Xenograft

Allo – Same species Auto – Same person Xeno – Animal (different species) An autologous transplant uses a person's own stem cells. ... In a reduced-intensity allogeneic transplant, doctors suppress the recipient's immune system enough so the donor stem cells can take root, or “engraft,” there. An autograft is a bone or tissue that is taken from a part of a person’s own body and transplanted into another. Often, surgeons will use a person’s own hamstring tendon to repair a damaged anterior cruciate ligament. Similarly, an autograft bone may be transplanted from a person’s hip to aide in a spinal fusion. Patients who undergo autograft procedures may experience increased postoperative pain from the second surgical (autograft) site. They may also require longer periods of rehabilitation. The use of allograft is advantageous because there is no second procedure required to remove and transfer a portion of the patient’s native bone or tissue. Surgical time may be...

Revenue Cycle Management - RCM

When you enter the field of US Healthcare, the first thing you notice right away is the unique terminology that keeps bombarding you! New medical terms and medical slang keep popping up. Added to it is the abbreviations, acronyms and what not.... You feel overwhelmed at first... But gradually with some patience you can master the terms which are used often in your office. I am listing below some common healthcare terms used in Insurance and Billing in RCM. Check them out and hope you will learn a word or two! BILLING TERMS When both you and your health insurance company pay for your health care expenses, it’s called cost sharing. Deductibles, coinsurance and copays are all examples of cost sharing. Understanding how they work will help you know how much you’ll pay. Deductible A deductible is the amount you pay for health care services before your health insurance begins to pay. How it works: If your plan’s deductible is $1,500, you’ll pay 100 percen...

Medical Coding Simplified

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