A Foolproof Guide to Medical Coding

Do you know there are plenty of posts are related to Medical coding that are just less informative and very random doesn’t even provide useful information at all

By reading the Headline  “ A Foolproof Guide to Medical Coding “ you might also think that this Is one of the most randomized and not even helpful post,

If you made a conclusion like this! I have to tell you a word “ This is Not a Random post “, This my research and my journey towards Medical coding. I am writing this post to make you realize the potential of the field Medical coding and to give you The Foolproof Guide to Medical coding

First of all we have to start with a basic question “ What is Medical coding and how it has been done”?

What is Medical coding :

It Is a process of transformation of health care diagnosis, procedures and medical equipment services into Universal alpha-numerical codes.

E.g. : Medical code for Heart Failure condition in Medical coding ICD is I50.9

Medical coding is mainly used for reimbursement ( i.e. claiming for health insurance money ) and guarantee high quality care in future visits

Medical coding Is the back bone structure in Revenue Cycle Management (RCM ),The process Medical coding makes claims Accurate with Higher precision.

How Medical coding will do :

Medical coding will be processed by the standard materials prepared and given by the organizations like AMA, NCHS, CMC etc

Medical coding process is mainly based on

• HCPCS
• ICD
• PCS  

HCPCS: 

Healthcare common procedure coding system, It is further divided to two types

1. HCPCS Level I Includes CPT (Current Procedural Terminology).
2. HCPCS Level II Includes Medical Devices and Medical Supplies like a syringe, wheelchairs, etc.

HCPCS Level I or CPT :

CPT stands for Current Procedural Terminology, CPT codes are the numerical codes used primarily to identify medical services and procedures done by qualified healthcare professionals

E.g.: 10060 Incision and drainage of abscess

In order to Lead correct CPT’S, we have to know the types of CPT,

There are 3 various types in CPT

A)Stand alone CPT

B) Indented CPT

C )Add on CPT

Stand alone CPT :

It includes all words in description, that means this is the complete CPT

There is no need to check another CPT, since the stand alone CPT includes all the data in it

Ex : Mastectomy for gynecomastia  19300

Indented CPT :

it is a type of CPT for which the full description can be known only by Proceeding the semicolon of proceeding entry referred.

If whenever semicolon appears in the CPT book then we have to follow the description present after the semicolon in order to find the correct CPT code

Ex 1 : intralesional Injections up to & Including 7 lesions 11900

Ex 2 : intralesional Injections more than 7 lesions 11901

Only difference between these CPTS would be the Number of lesions

            Ex  : intralesional Injections up to & Including 7 lesions & More than 7 lesions 11900 & 11901

We have to consider that description before semicolon would be standard and that description will be applicable for the Next CPT that present in that category

Here when ever we are reading 11901 CPT we should understand that there is semicolon At 11900 hence the description before the semicolon will be applicable for next CPT

I.E 11901 as well hence we should pronounce 11901 CPT as injection intralesional More than 7 lesions not as just more than 7 lesions

Add on CPT :

This CPT is denoted with the symbol “ + “ before the CPT code, It is an extension to the Main CPT but not as indented CPT

Add on CPT’s are never allowed to code in the absence of main CPT & these CPT are never permitted to code as Primary CPT , we should use them as secondary only

Ex : Excision of breast lesion open; single lesion 19125

      Excision of breast lesion open; Each additional lesion lesion 19125,19126

If the excision of one breast lesion is only takes place then we have to code 19125 CPT only, If the excision of two breast lesion takes place then we have to code 19125 for the first lesion along with an addon CPT i.e. 19126 this is for second lesion

Here the order of CPT would be 19125,19126

CPT is further divided into 3 categories

Category 1 : This Includes Regular procedures & E&M services

Category 2 : These set of codes that can be used for performance measurement

Category 3 : Temporary codes used for emergent technology

Category 1 CPT Codes :  

These are codes which are commonly used to code procedures and Evaluation and management services

These codes five digit codes framed with numerical numbers only

Category 2 CPT Codes :

These are a set of supplemental tracking codes that can be used for performance measurement.

These codes are intended to facilitate data collection about the quality of care rendered by coding certain services and test results that support nationally established performance measures and that have an evidence base as contributing to quality patient care.

The use of these codes is optional. The codes are not required for correct coding and may not be used as a substitute for Category I codes and these are never used as pdx

These codes are ends with the letter “ F “

Category 3 CPT Codes :

The following section contains a set of temporary codes for emerging technology and services, Category III codes allow data collection for these services/procedures.

these are never used as pdx and these codes end with letter “ T  “

HCPCS Level 2 :

Supplies and materials like sterile trays/drugs are usually included within the procedures but we have to report the supplied code separately List drugs, trays, supplies, and materials provided by specific supplies code

        Ex : let’s say a patient Is provided with therapeutic injection by morphine drug

Here the procedure CPT is 96372  it includes injection of the drug but we have to report supplies code separately

Hence the order of CPT would be  96372, J2270, Here CPT J2270 will be the HCPCS level 2 supplied Materials CPT

ICD :  

ICD stands for International Classification of Diseases

It is an international standard diagnostic tool in which all the diseases are categorized, nothing but Diseases and symptoms classified into alphanumeric numbers

ICD has a major in medical coding to get the right E&M and specific diagnosis in a short time with accuracy

Present we are using ICD 10 CM,  it means it is the 10TH  revision of the Whole set of ICD’S that resemble with “ 10” and CM Means Clinical modifications,  every year on Oct 1st ICD has undergoes some changes this resembles with clinical modifications “ CM”

Origination of ICD :

Centers for Medicare and Medicaid Services (CMS) and the National Center for Health Statistics(NCHS) two departments within the U.S. Federal Government’s Department of Health and Human Services (DHHS) provide the following guidelines for coding and reporting using the International Classification of Diseases

These guidelines have been approved by the four organizations those are American Hospital Association (AHA), the American Health Information Management Association (AHIMA), CMS, and NCHS

ICD 10 Has  4 Alphabetic indexes and one tabular list to lead the codes, HIPAA plays a major role in ICD

PCS:

PCS stands for Procedural Coding System, it Is mainly used in the In-Patient setting for the process called IP-DRG

These codes are framed with alphanumerical numbers just like ICD, By using the above materials Medical coders will process the Medical to the next level

Medical coding career :

Medical coding career is a fastest growing career from the past few years it has plenty of jobs available in the market, But the employee gap is still un-filled.

In Medical coding employee pay role is very descent and it is learning friendly Field, Even in this pandemic situation also medical coders receives high salaries

by doing WFH (Work from Home). Medical coding is an Evergreen field that never touch Recession.

Medical coding salary :

Salary is a reward to our work; more you work and more you get that is the potentiality of this field.

The Average salary of a fresher in medical coding (In India) is 1,50000-2,50000, If a coder has experience along with certification, then the salary will be much

more and Attractive Hikes at the end of each year.

Note: When comes to medical coding salary is an amount that comes parallelly by doing work means if you work more then you will get more this is the

potentiality of this field.

A lot of MNC’S are providing Medical coding jobs, it is good to be part of that kind of MNC’S.

Medical coding course :

To become a Medical coder requires training and certification,

we should know about the basic policy of Medical coding i.e. Patient Privacy and security of the data.

There are some academies providing certifications in Medical Coding.

AAPC

AHIMA

Some of the Popular certifications are

CPC (Certified Professional Coder) by AAPC

CCS (Certified Coding Specialist) by AHIMA

A lot of training Academies are providing Medical coding training in Andhra Pradesh and Telangana those are

Way to Medical coding Academy, Vijayawada, Andhra Pradesh

Transcode institute, Hyderabad, Telangana

Medesun global, Hyderabad, Telangana

Ikya Global, Vijayawada, Andhra Pradesh

Duration of Medical coding training program:

Generally, there will be two training programs are available in the market

01.Medical coding Certification program – It is with two months duration

02.Medical coding career orientation program – it is with one month duration

Commonly asked questions:

Conclusion :

Medical coding is a conversion of health care data into alphanumerical numbers

Medical coding should be done by the following of materials like ICD, CPT, HCPCS-II

HCPCS is further divided into level I and II

CPT further devided in to 3 categories

ICD has divisions of alphabetic index and tabular list

PCS is mainly used in in-patient services

Medical coding career is having high demand

Medical coding salary ranges from 12,500 -50,000 rs per month

Medical coding requires training and certification CPC, CCS are the most privileged certification in Medical coding

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