Medical coding

1. Medical Coding

2. Medical Coding -
Introduction
 Thisreferstotheprocessof translatingmedicalinformationintosimple
codesforthepurposeofthedocumentingmedicalrecordsandinforming
accuratemedicalbilling.
 Medical Coding is the transformation of healthcare diagnosis,
procedures, medical services and equipment into universal medical
alphanumericcodes.
 AAPC–AmericanAcademyofProfessionalCoders.

3. Medical Coding -
Introduction
 Thedoctorwillofficiallyreportthisdiagnosis.
Why Medical Coding is needed?
 Visit a doctor with symptoms like fever, sore throat and enlarged lymph
nodes , these will be recorded along with the procedures the doctor
performsandthemedicinethedoctorprescribes.
 The portion of that report that will be coded contains a diagnosis, a
procedure,andaprescription.

4. Medical Coding -
Introduction
 There are number of sets and
subsets of code that a
numerical code must be
familiarwith.
Why Medical Coding is needed?
 It’s the medical coders jobs to translate every bit of relevant
information patient’s visit into numeric and alphanumeric codes,
whichcanthenbeusedinthebillingprocess.

5. Medical Coding -
Introduction
 Importantconsideringthehundredsofmillionsofvisits,procedures,and
hospitalizationsannually.
Why Medical Coding is needed?
 Apatient’sdiagnosis,testresults,andtreatmentmustbedocumentfor
reimbursement.

6. Medical Coding -
Introduction
What codes depict?
What kind of visit this is
Symptoms that patient is showing
What test the doctor does
What the doctor diagnoses the patient with

7. Medical Coding -
Introduction
 Codes,thatsignify apre-existingcondition,needtobeaplacedinavery
particularorder.
Why Medical Coding is needed?
 Thecoderreadsthehealthcareprovidersreport.Translateeachbitof
informationinto acode.
 Everycodesethasitsownsetofguidelinesandrules.

8. Medical Coding -
Introduction
Why Medical Coding is needed?
 Themedicalcoderenterstheappropriatecodesintoaformorsoftware
program.
 Oncethereportiscoded,itspassedonthemedicalbiller.
 Codingaccuratelyandwithinthespecificguidelinesforeachcodewill
affectthestatusofaclaim.

9. Medical Coding -
Introduction
What is Medical billing /Claim?
 Medicalbillerstaketheinformationfromthemedicalcoderandmakea
billfortheinsurancecompanycalledaclaim.
 Themedicalbillertakesthecodes,createsaclaim outoftheseusinga
formoratypeofsoftware.
 Thebillerthensendsthisclaimtotheinsurancecompany,which
evaluatedandreturnsit.
 Thebillerthenevaluatethisreturnedclaimandfiguresouthowmuchof
thebillthepatientowes,aftertheinsuranceistakenout.