Medical Coding Anyway?
by Jenna Russell
You hear it all
the time, lots of talk about medical billing and coding and you may
wonder; do Doctors carry come sort of decoder ring or tap Morse code
to the nurses to get the right meds? Ok, that might make for a good
episode of “Scrubs” but no, no such luck. The reality of medical
coding is much more complex and yet it provides a universal system
to simplify health care.
Up until the 20th
century there was no global method of classifying diseases. But by
The World Health Organization (WHO) established The Manual of
the International Classification of Diseases, Injuries and Causes of
Death (ICD). The ICD then became the universally accepted method of
distinguishing all manners of injuries and diseases.
are now used in every aspect of health care, from a simple doctor’s
visit to brain surgery. Every disease, every condition and procedure
is assigned a specific numeric code. These codes are used by medical
professionals worldwide to communicate with each other and with
insurance providers. These codes have unified the practice of
medicine internationally and established a standard for billing and
payment from private and government programs. While utilizing a
common coding system has helped to prevent miscommunications between
institutions involved in all levels of the health care process; it
is yet an imperfect system which can, in some cases, cause billing
and coverage problems for patients.
Kinds of Medical Codes
overarching system, there are several different kinds of medical
codes. The thee top level categories are the ICD, the Current
Procedural Terminology (CPT) and Healthcare Common Procedure Coding
System (HCPCS). The two groups most commonly used are the ICD and
the HCPCS. The ICD has undergone several revisions and the standard
version being used now in America is the 9th edition
known as the ICD-9-CM. Currently, the
Center for Medicare & Medicaid Services has plans to release an
updated version of the ICD in 2013.
The HPCS has
two levels, level one is based on the CPT and used for doctor’s
services and outpatient procedures. These codes are used in
hospitals and the diagnostic process. Level two is used primarily by
medical vendors and suppliers. While they may serve different
purposes, all of these codes are vital in the care giving and
breaks down even further into numerous sub-groups, used by various
sectors of the medical community. The dental field has developed the
Code on Dental Procedures and Nomenclature (CDT). Mental health care
professionals have begun using the Diagnostic and Statistical Manual
of Mental Disorders (DSM-IV-TR) and the Prescription Drug industry
utilizes the National Drug Codes (NDC).
codes may seem removed the daily routine of most people, the fact is
medical codes of all kinds play a huge role in our lives. We depend
on accurate coding to receive the proper medical care, to pay for
services rendered and to qualify for medical coverage. The absence
of a single code, or the wrong code in the wrong place could easily
wreck havoc on a patient’s life. That’s part of the reason why
anyone involved in the medical coding process must undergo
medical billing and coding certification. Only trained
professionals are allowed to deal with the specifics in medical
coding in order to protect doctors and patients and to insure proper
payment. Without this coding system there would be discourse
throughout the medical profession, resulting in incongruities,
errors and potentially even fatalities. In fact, the medical coding
system is essentially the foundation of the entire modern
international health care system.
is a writer for
medicalbillingandcoding.org. She has extensive experience
writing and working with health care education programs.