Medical coders play a vital role within the revenue cycle process, ensuring that healthcare systems, hospitals, and medical professionals receive appropriate reimbursement for their provided services.
Here are 14 key points about medical coding:
- Medical coding is described by AAPC as the conversion of healthcare diagnoses, procedures, medical services, and equipment into standardized medical alphanumeric codes.
- Once a medical coding expert assigns a code to a specific healthcare service or procedure, that code is included on an insurance claim. This code informs the insurer about the owed reimbursement for the care and aids in determining the patient’s billing amount.
- Coders use various classification systems, including the Current Procedural Terminology, ICD-10, and the Healthcare Common Procedure Coding System Level II, to assign codes.
- The initial medical coding system, introduced by French physician Jacques Bertillon in the late 1800s, was called the Bertillon Classification of Causes of Death. It was utilized for mortality classification and tracking.
- Dr. Bertillon’s system was later renamed the International Statistical Classification of Diseases, Injuries and Causes of Death in the 1940s. The U.S. transitioned from ICD-9 to ICD-10.
- The shift from ICD-9 to ICD-10 represented a move toward more specific codes. ICD-9 had 3,824 procedure codes and 14,025 diagnosis codes, while ICD-10 has 71,924 procedure codes and 69,823 diagnosis codes.
- Over a year after the ICD-10 implementation on October 1, 2015, CMS ended the leniency period for ICD-10 claims auditing and quality reporting. Providers now need to code based on clinical documentation specificity.
- The Bureau of Labor and Statistics projects a 15 percent growth in job opportunities for medical records health information technicians (medical coders and billers) from 2014 to 2024, exceeding the 7 percent average growth for all occupations.
- The medical transcription, clinical documentation, and coding market is expected to grow by 12.9 percent from 2016 to 2020, as projected by Black Book Market Research.
- Medical coders and billers have distinct roles. Coders review clinical documentation and assign standard codes using ICD-10 classifications, while billers handle claims processing and reimbursement submission to payers.
- Accurate coding necessitates proper clinical documentation. Incorrect or insufficient documentation can lead to code assignment issues, potentially resulting in claim rejections by insurers.
- In 2016, medical coders/billers in health systems earned an average annual salary of $52,320, while those in large group practices had an average salary of $49,452, according to AAPC.
- While not requiring bachelor’s or master’s degrees, medical coders must possess strong knowledge of anatomy, physiology, and medical terminology, as emphasized by AAPC.
- The productivity of coding declined the most for inpatient records in 2016, followed by clinical documentation in outpatient and emergency department settings, according to himagine’s 2016 HIM Benchmark Report.
Adrienne Younger, RN, certified clinical documentation specialist manager at Ardent Health Services, advised hospitals to collaborate closely with coders. By providing resources to enhance their understanding of the clinical aspect of coding, coders become more engaged and contribute to improved patient outcomes. Collaboration reinforces their role as valuable members of the hospital team.