First Do No Harm

What Is 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.

The Basics

Up until the 20th century there was no global method of classifying diseases. But by 1949 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.

Medical codes 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. 

Different Kinds of Medical Codes

Within the 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 payment process.

The system 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).

Why They Matter

Though medical 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.

 

Jenna Russell, is a writer for medicalbillingandcoding.org. She has extensive experience writing and working with health care education programs. 


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