Physicians and hospitals depend upon accurate medical coding to ensure they are properly paid by patients and insurance companies. Coding is a very time-intensive, precision-oriented procedure, and errors caused by understaffed facilities or improperly trained coders can cost healthcare providers thousands of dollars a year. While medical coding is an integral part of business practice in all facilities, coding in doctors’ offices can be different than coding in hospitals and other larger institutions.
Streamlined Specialist Coding
Since physicians in offices tend to specialize, coding is often limited to a more streamlined selection. For example a gastroenterologist’s practice will use codes such as ICD-9-CM (Internal Classification of Diseases, Ninth Edition, Clinical Modification) 520-579 for the digestive system. These codes will range from diseases of the oral cavity, salivary glands, and jaws to diseases of the pancreas, chronic liver disease, and disorders of the gall bladder and biliary tract. Medical coders who work for gastroenterologist physicians’ offices will work chiefly with the 59 codes commonly used for the digestive system. These coders have often been trained specifically in that particular specialty, so in the event that a patient presents with what appears to be gastrointestinal in origin, but in fact turns out to be something else, a coder will then have to be introduced to a whole new range of codes, which can create a backlog of medical records in the physician’s office.
Broad-Based Hospital Coding
Hospitals, on the other hand, are filled with patients with a myriad of medical conditions. In emergency rooms, patients present with varying symptoms that may be equivocal in nature. As a result, numerous tests may be ordered in an acute situation. For example, a person can present with symptoms of a heart attack, yet there may be other accompanying signs that lead the emergency room physician to suspect the symptoms are not necessarily cardiac in nature, but might possibly indicate an acute esophageal disorder, or perhaps a lung condition, disorder of the digestive system, or even anaphylactic shock—signs of which can all mimic a heart attack. For these reasons, a variety of tests may be performed, using a wide range of codes.
Once a patient has been admitted to a hospital, a myriad of different codes may continue to be applicable, such as those for diagnostic and interventional radiology, surgery and surgical pathology, lab analysis, biopsy, vascular procedures such as arterial and venous thrombolysis—the list of codes used in hospitals is gargantuan. For this reason, hospitals must employ a large staff of coders who are familiar with the entire catalog of codes in the ICD-9 system.
New Updates to Coding Requirements
New governmental regulations are about to making medical coding even more complicated. On October 1, 2015, the United States will update the current ICD-9 system used for medical diagnoses and inpatient procedures to ICD-10. ICD-10-CM will be used in all U.S. healthcare settings for diagnoses and will include over 68,000 diagnosis codes—nearly five times as many codes as ICD-9-CM
ICD-10-PCS will be used in U.S. inpatient hospital settings and replaces ICD-CM Volume 3. This coding is much more specific than the previous coding system.
All physicians and hospitals covered by the Health Insurance Portability and Accountability Act (HIPPA) will be affected by these changes. Claims using the ICD-9 codes for services provided on or after the compliance date will create billing problems, especially in the cases of Medicare or Medicaid claims. For this reason, it is imperative that physician and hospital settings plan ahead to be in compliance—their bottom line will depend upon it.