The health care industry becomes more complex each year. Advances in research help create more medical devices and more options for treatment. The Affordable Care Act (ACA) means that more people are covered by insurance. As the pool of insured patients increases, so does the need to file medical bills with insurance companies. The coding used on medical bills is critically important in the health care system.
Medical coding drives revenue
When a person receives any sort of medical treatment or procedure, the health care provider must use a standard set of codes to generate an accurate medical bill. The Practice Suite’s free ICD 10 code lookup website explains that a health provider cannot get a medical bill paid without accurate coding.
The vast majority of medical bills are submitted to insurance companies. Doctors, hospitals and treatment centers rely on insurance claims for the majority of their revenue. If there are coding errors, the billing must be corrected and resubmitted. This means that payments are delayed, which can have a huge impact on the cash flow of the medical facility.
The ICD-10 system
ICD is the clinical cataloging system for all health issues worldwide. ICD-10 is the 10th revision of the World Health Organization’s coding system. The system is used to note diseases and treatments on an individual’s health records. Medical providers generate bills using the ICD-10 coding system.
The current version of ICD includes two systems. CM (Clinical Modification) is a broad category of coding for clinical and diagnostic services. PCS (Procedure Coding System) is a coding category for inpatient hospital treatment.
ICD-10 was enhanced to be more specific. For example, if a patient receives treatment on their arm, the coding system can now document whether it was the left or right arm. This 10th coding revision can provide more detail on when the patient saw a caregiver, and how the treatment of an illness is progressing.
Centers for Medicare and Medicaid
Medicare and Medicaid provide services to the poor, elderly and their children. These programs reimburse thousands of health care organizations for the services they provide. These government agencies provide information on how health care professionals should submit bills for payment.
ICD-10 has simplified the coding system, so that health care providers are able to locate codes quickly. The updated system has also added codes for many new devices and procedures. By providing additional codes, IDC-10 reduces the need to provide more information to explain a particular claim.
Here are some examples of how the ICD-10 has enhanced the coding system:
· The obstetrical codes (pregnancy, labor and delivery) now include the particular trimester of the pregnancy.
· Many additional codes have been added for a variety of injuries and the external causes of the injuries.
· The new coding system is consistent with the Diagnostic and Statistical Manual of Mental Disorders (DSM IV). This manual is used to identify mental issues for treatment. Professionals in the mental health field can find their specific codes more quickly.
The coding system
Each of the codes follows a particular pattern. A typical code starts with letters then numbers. If the code needs to be more specific, additional letters can be added after the numbers. The ICD-10 codes explain the specific body part, the approach for treatment and any medical device used.
It’s critically important for all health care providers to understand the new coding system. Make sure that you have properly trained staff, so that your medical bills are properly coded. Using the new system properly will help you get your bills paid in a reasonable amount of time.