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Medical Coding
Medical coding is a more like translation. Medical Coders take reports from doctors, which includes patientâ??s condition, doctorâ??s diagnosis, prescriptions, procedures the doctor or healthcare provider performed on the patient, and turn that into a set of codes, which make up a essential part of the medical claim.
According to the Centers for Disease Control (CDC), there were over 1.2 billion patient visits in the past year. At a minimum even if there are 5 codes derived from each visit, this accounts to near about 6 billion individual pieces of data, which is an almost unrealistically low estimate, that needs to be transferred and interpreted for statistics and reimbursement each year.
Coding allows for uniform documentation between medical facilities. Having uniform data allows for efficient research and analysis, which government and health agencies use to review and analyze health trends much more efficiently.
Types Of Codes You Need To Know:
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ICD (Classification of Diseases, or ICD codes )
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CPT ( Current Procedure Terminology, or
CPT codes )
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HCPCS ( Healthcare Common Procedure Coding System )
ICD : International Classification of Diseases, or ICD codes
These are diagnostic codes that create a uniform vocabulary for describing the causes of injury, illness and death.
The code that is currently in use in the United States is ICD-10-CM. This means it is the tenth revision of the ICD code set, and â??-CMâ?? at the end stands for â??clinical modification.â?? The Clinical Modification significantly increases the number of codes for diagnoses.
This increased scope gives coders much more flexibility and specificity, which is essential for the profession. To better understand how important the clinical modification is, the ICD-10 code set has 14,000 codes. Its US model clinical modification, ICD-10-CM, contains over 68,000.
ICD codes are used to represent a doctorâ??s diagnosis and the patientâ??s condition. In the billing process, these codes are used to determine medical necessity. Coders must make sure the procedure they are billing for makes sense with the diagnosis given.
CPT: Current Procedure Terminology, or CPT codes
These codes are used to document the majority of the medical procedures performed in a physicianâ??s office. This code set is published and maintained by the American Medical Association (AMA). These codes are copyrighted by the AMA and are updated annually.
CPT codes are five-digit numeric codes that are divided into three categories. The first category is used most often, and it is divided into six ranges. These ranges correspond to six major medical fields: Evaluation and Management, Anesthesia, Surgery, Radiology, Pathology and Laboratory, and Medicine.
The second category of CPT codes corresponds to performance measurement and, in some cases, laboratory or radiology test results. These five-digit, alphanumeric codes are typically added to the end of a Category I CPT code with a hyphen. Category II codes are optional, and may not be used in the place of Category I codes.
The third category of CPT codes corresponds to emerging medical technology. As a coder, youâ??ll spend the vast majority of your time with the first two categories, though the first will undoubtedly be more common.
HCPCS: Healthcare Common Procedure Coding System
Healthcare Common Procedure Coding System (HCPCS), commonly pronounced as â??hick picks,â?? are a set of codes based on CPT codes. Developed by the CMS (the same organization that developed CPT), and maintained by the AMA, HCPCS codes primarily correspond to services, procedures, and equipment not covered by CPT codes. This includes durable medical equipment, prosthetics, ambulance rides, and certain drugs and medicines.
Medical Coding Vocabulary & Key Terms
There are a number of important terms you will want to familiarize yourself with as you learn more about coding. Let us look at some of these now.
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Category (CPT)
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Category (ICD)
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Clinical Modification
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CMS
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CPT
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Hcpcs
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E-Codes
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Evaluation And Management (CPT)
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ICD
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Modifier
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Modifier Exempt (CPT)
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NCHS
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Pathology
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Subcategory
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Subclassification
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Technical Component
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V-Codes
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Who
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Z-Codes
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Modifiers
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Conventions)
Brackets []
Parenthesis ()
Excludes
Includes
See
See Also
Code First
Use Additional Code
Medical Billing
Medical billers act as the financial waypoint between patients, providers, and payers. Without billers, healthcare providers couldnâ??t be reimbursed for the procedures they perform. The training program covers the all concepts and guidelines that underpin the billing process. You will learn how the insurance process works, and what types of payers affect the reimbursement process. We will discuss Medicare, Medicaid, and the regulations enforced under the Health Insurance Portability and Accountability Act (HIPAA). Review the below course curriculum for further understanding on our training program.
Chapter 1 : Introduction to Medical Billing
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About Medical Billing
The Basics Overview
Gathering Data / Entering Data
Paper Claims
Electronic Claims
Posting Payments
Generating Reports
Billing your clients
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Types of Insurance Coverage
Group Health
Individual Policies
Medicare
Medicaid
Personal Injury
Workers Compensation
Tricare
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Procedures and Diagnoses
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Insurance Claim Processing
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Claim Payment
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Report Generation
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Resources
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Study Guide, Examination
Chapter 2 : Understanding Office Forms
Chapter 3 : Understanding the CMS 1500 Form
Chapter 4 : Understanding Codes
Chapter 5 : Life cycle of an insurance claim
Chapter 6 : Working with Billing / Practice Management Software
Chapter 7 : Medical Billing / Practice Management Software Application
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Medical Terminology
This comprehensive medical terminology combination course covers the medical language and terminology used by health care professionals everywhere.
If you are interested in pursuing a health and science career requiring the ability to communicate with Physicians, Physician offices, Medical Professionals, Healthcare BPOs, KPOs, Insurance Jobs, etc. this course will meet all your needs.
We will start with the very basics of medical terminology, reviewing word roots, prefixes, and suffixes that make up medical words. We will then move on to each body system where we will work on recognizing and defining their related medical terms. This comprehensive review of medical terminology will not only benefit those new to medical terms used in medicine today, but also act as a refresher for those already experienced in medical terminology.
In easy to review lessons, our course material will not only give you a solid foundation in medical language, but can be completed in less than 30 days! You will analyze individual word parts such as prefixes, suffixes and word roots, along with learning body system dynamics, basic medical language, body orientation, health, wellness, and disease terms. You will learn the basic components of medical terminology as it relates to each body system plus the instruments used in assessment will also be reviewed.
So if you are planning on pursuing a career in medical transcription, medical billing or medical coding, physician's secretary or medical support staff, or you just need a review or extra tutoring for your anatomy and physiology classes, or maybe you want a jump start in the medical field before starting college; or perhaps you are just interested in learning the latest in medical language -- you can begin today -- enroll right now!
"Learn and recognize word roots, prefixes, and suffixes used in medical language today. Learn how to combine words to create meaningful medical conditions as well as comprehend their definition and know the correct spelling. In this medical terminology course, we will cover medical terms related to all major body systems mentioned below.
Whether are new to the medical profession or you just need a refresher class, this medical terminology course is for you !
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Basic Word Structure
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Terms Pertaining to the Body as a Whole
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Suffixes
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Prefixes
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Digestive System
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Additional Suffixes and Digestive System Terminology
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Urinary System
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Female Reproductive System
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Male Reproductive System
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Nervous System
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Cardiovascular System
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Respiratory System
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Blood System
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Lymphatic and Immune Systems
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Musculoskeletal System
Bonus Add-ons
Chapter 1. Understanding HIPAA
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Introduction to HIPAA
Health Insurance Portability
Accountability
Administrative Simplifications
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Transaction and Code Set Standards
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Unique Identifier Standards
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Security and Electronic Signature Standards
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Implementation Specifications
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Administrative Safeguards
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Physical Safeguards
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Technical Safeguards
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Privacy and Confidentiality
Consumer Control
Boundaries: Medical Records
Security of PHI
Accountability: Medical Records
Public Responsibility
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Consent and Authorizations
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Marketing and fundraising
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De-Identification
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Business Associates
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Penalties for non-compliance
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Resources
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Study Guide, Examination
Chapter 2: Calculating Co-pays and deductibles
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100 problems and answer key
Chapter 3: Understanding Workers Compensation
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Introduction to Workers Compensation
Medical Claims
Temporary Disability
Permanent Disability
Vocational Rehabilitation
Survivor benefits
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Federal Work Com Overview / Claim Filling
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Federal Work Com Overview / Claim Filling
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State Work Comp Overview / Claim Filing
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First Report of Injury
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CMS 1500 Completion
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Appeals and Adjudication
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Fraud and Abuse
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Successful Claim Filing tips
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Glossary of Terms, Resources, Study Guide
Job Duties : MB vs MC
Comparison Medical Billing & Medical Coding
Medical billers work primarily with patientâ??s data and insurance companies on claims submissions, and often perform more customer-service oriented tasks than coders. Medical coders generally work with healthcare professionals to accurately categorize the services and products provided to patients. The following tables detail the differing career tasks and trajectories of billers and coders.
Medical Billing Medical Coding Entering data with proprietary billing software Communicating with physicians, nurses, and other healthcare professionals to categorize the services a patient has received Submitting claims to insurance companies Applying CPT, HCPCS, and ICD-10 CM standardized codes to patient records to accurately reflect the services received Following up with patients, healthcare professionals, and insurance providers to make sure claims are paid for Entering data through Electronic Health Record (EHR) and Electronic Medical Record (EMR) software used in hospitals and physiciansâ?? offices Managing account payments and invoices Examining operative reports used during surgery to apply procedure codes Investigating rejected or denied claims Performing medical chart audits when a claim is denied Ensuring that physicians and patients receive reimbursements from insurers Remaining up-to-date with the latest revisions to coding standards and federal regulations Verifying the accuracy of standard healthcare codes used by medical coders to classify services and products Examining patient charts and histories to ensure coding accurately reflects a patientâ??s medical care -
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