Medical Coded Data Analysis

In the health care system, there are a lot of codes that help diagnose, treat, and discharge patients daily. Codes help nurses

Apply accurate, complete, and consistent coding practices for the production of high-quality of healthcare data.

Medical billing and coding specialists usually work in office settings. A computer, a telephone and appropriate documents are all used on a daily basis. Unlike other medical professions, there is little contact with patients. Medical coders work closely with healthcare providers and insurance carriers to gather and provide accurate billing information, but most communication take place in the form of phone conversations and mailings.

"Medical coding professionals provide a key step in the medical billing process. Every time a patient receives professional health care in a physician’s office, hospital outpatient facility or ambulatory surgical center (ASC), the provider must document the services provided. The medical coder will abstract the information from the documentation, assign the appropriate codes, and create a claim to be paid, whether by a commercial payer, the patient, or CMS." (Aapccom, 2015) It is very important that billing coders have a full understanding of how to properly use medical codes to prevent denial of claims submitted.

Coding systems are used in the inpatient and outpatient settings for the classification of patient morbidity and mortality information for statistical use. The World Health Organization (WHO) developed the Ninth Revision, International Classification of Diseases (ICD-9) in the 1970s to track mortality statistics across the world. The International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM), is the adaptation the U.S. health system uses as a standard list of six-character alphanumeric codes to describe diagnoses. Globally utilizing a standardized system improves consistency in recording symptoms and diagnoses for payer claims reimbursement, as well as clinical research, and tracking purposes.

Read the article Diagnosis Coding and Medical Necessity: Rules and Reimbursement by Janis Cogley located on the AHIMA Body of Knowledge (BOK) at http://www.ahima.org.

This standardized dialect is also pertinent for medical schooling and teaching in addition to clinical research and studies conducted by scholars, scientists, and physicians by providing a valuable foundation for domestic and coast-to-coast operation evaluations. CPT is used to describe doctor’s services, a vast amount of administrative services in addition to operating services executed in medical facilities, treatment care centers, and outpatient divisions. Providing support for clerical duties and functions such as processing medical claims and initiating strategies and procedures for the evaluation of clinical care is another cause of relevance for CPT. The system also meets the need for tracking trends and identifying improvements, plus progression goals and scaling the value of healthcare services received by patients. The CPT coding system provides physicians throughout the United States with a consistent method for classifying and coding clinical procedures which in return provides a more efficient tool for recording and reporting task that were completed. Physicians, scholars and payors, have been dependent upon CPT to interconnect with other fellow associates, patients,

Quality physician documentation is not only essential to providing superior clinical communication, but also allows for the delivery of useful data that “supports quality metrics, acuity of care, billing, and accurate representation of medical conditions” (Rosenbaum et al., 2014). The Centers for Medicare and Medicaid Services (CMS) uses a system to classify Medicare patient’s hospital stays into various groups in order to facilitate payment of services called Medicare Severity-Diagnosis Related Group (MS-DRG). Some payers also use all patient refined (APR)-DRG reimbursement systems. MS-DRG groups are outlined by a specific collection of patient characteristics which include areas specific to the “principle diagnosis, specific secondary diagnoses,

One of the greatest milestones in the United States health system is the use of electronic health records codes to ensure consistency in diagnosis and treatment procedures provided by physicians (Romano & Stafford 2011). The purpose of the case scenario of the sixteen year old female who visits the emergency department is to show how electronic health record coding is done and its impact on health reimbursement. The International Classification of Diseases (ICD) and the Current Procedural Terminology (CPT) codes are brought out well in the case study showing how they help in ensuring physician consistency in coding diagnosis and treatment procedures for the purpose of health reimbursement.

The major responsibility of a Medical Coder is to add standardize codes to test, treatments, and procedures in the patients records for the medical biller to use the color report to collect the payments from the insurance provider and the patient.

Medical coding is similar to conversion. It is the process of changing medical diagnoses and procedures into numbers, letters, or both. A diagnosis is the process of determining by examination the nature and circumstances of a diseased condition. For every injury, diagnosis, or medical procedure, there is a matching code. There are a number of sets and subsets of code we must be familiar with. The first is the International Classification of Diseases, or the ICD9-CM, which correspond to a patient’s injury or sickness. Next, the Current Procedure Terminology, or CPT codes, is related to the type of services the provider completed on the patient. . Providers use two types of claim forms to bill insurance for a patient’s services and procedures.

E codes classify environmental events and other conditions as causes of injury and other adverse effects. The Centers for Disease Control may use it to show the public a statistic about a certain event. They may also be used to show and classify environmental events, such as floods or tornadoes. OSHA also tracks the use of E codes to identify causes of accidents on, and off, a job. For example, if a restaurant was serving spoiled food to their patrons, they would more than likely get sick. With more than just the occasional case of food poisoning coming into a hospital, they may alert the CDC to give them information using E codes to move forward and correct any issue.

A coder is someone who work in the back office, which means not a lot of interaction with patients. Medical coders have a lot of responsibilities such as reviewing, completing, and processing medical claims, to help physicians and hospitals be reimbursed by third party payers or self-paid payers. Each procedure, diagnosis, and encounter or service has

There is an accentuation on the need for quality of coded data with the use of computer-assisted coding in healthcare organizations to assure compliance is being met with regards to the increasingly multifaceted quality reporting requirements.

There exists many data coding standards in healthcare. The ICD is the international standard of the classification of diseases used by a multitude of healthcare professionals  (“International Classification of Diseases”, 2016). Its latest version, ICD-10, has numerous benefits including helping doctors more correctly report conditions and differentiate payment by treatment type, more efficient disease management, and helping to prevent fraudulent claims as a result (Schwartz, 2013). In terms of current use, more and more countries have used it for reporting morbidity. In the United States, it has been the official standard for death certificates since 1999 (Brouch, 2000). For the future, ICD-11 is stated to be released to include recent advancements in healthcare and medicine and will allow open access for editing (“International Classification of Diseases”, 2016). LOINC® is used to standardize data for laboratory and medical clinic measurements (McDonald et al., 2003). Benefits include helping separate lab systems interpret shared lab test data, improving the efficiency of ordering lab tests from many labs, and also aiding in generating public health clinical data (“3.2 Benefits of LOINC”). Current usage is categorized into three areas:  laboratory,  clinical, and HIPAA specific proposals. The majority of US federal agencies and public health departments like New York State