Medical Billing and Coding

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Medical Billing and Coding

Corinthea Madden

CISS 109/3296
Professor Stanton
March 24, 2012

Corinthea Madden
Professor Stanton
CISS 109/3296
March 24, 2012

Medical Billing and Coding

Medical billing and coding is the process of receiving and submitting error free claims to insurance companies to receive payment for services by a health care provider. Billing and coding is almost like story telling. Attention to detail and familiarity with anatomy, medical terminology and diseases enhance the coder’s ability to retell the events during a patient’s encounter by using diagnosis codes. The medical billing process is the interaction between health care providers and the insurance companies. The entire process is known as the billing cycle. It can take anywhere from several days to several months to complete and require several interactions until a resolution is reached. Billing and coding is not a new IT field and has been around for many decades. For several decades medical billing was done almost entirely on paper. The need for standardized information has grown since the beginning of the Medicare program in 1965. As new systems for reimbursement were developed, a need for specialized information grew and several types of coding methods were created, in addition to one that was already in existence. The International Classification of Disease (ICD) was developed and published by the World Health Organization (WHO) about seventy-five years ago to classify disease and diagnoses. This is currently used throughout the world and has been through 10 different modifications. The U.S. is now using the ICD 9-CM (ninth clinical modification), while many others countries have switched to ICD 10. Other coding systems used with ICD 9-CM are CPT 4 (Current Procedural Terminology, 4th Revision) which is used for coding operations and diagnostics procedures and HCPS(Healthcare Common Procedural Coding Systems), used for coding medication, supplies and other services not covered by CPT. Additional coding systems exist in the U.S. and are used for research, mental health and pathology. The basic ICD 9 system was adapted for the use by hospitals, physicians and insurance companies. The ICD 9 system was revised in 1993 to allow better reporting and classifying of diseases. A medical biller or coder is also known as a diagnostic coder, medical records tech or medical coder-they are responsible for analyzing clinical statement of events and diagnosis entered by the attending provider and assigning the correct diagnosis code to the greatest specificity. Medical coders work in hospitals, clinics, surgery centers, long-term care facilities, insurance companies, dental offices, some health care agencies, consulting firms coding, billing services and government agencies. They typically work under the supervision of the Health Information Manager or chief Financial Officer. They must carefully review the medical documentation from the physicians so they can obtain detailed information regarding the disease, injuries, surgical operations and other procedures. That information is then translated into numeric codes. The coding specialist assigns diagnostic and procedural codes using a universally recognized coding system. They must pay careful attention for correct code selection so it is compliance with federal regulation and insurance requirements. The medical codes are used for reimbursement of hospital and physician claims for Medicare, Medicaid, and insurance payments.

Students interested in pursuing a career in medical coding should take high school courses in algebra, biology, computer skills, English, typing, offices procedures, data processing, and health occupation. They should have a high school diploma or equivalent. An Associate’s Degree is recommended but training may be available on the job as well as through continuing education classes offered by state associations. They must pass an examination offered by the...
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