Coding Secrets that You Need to Know

June 17,2016 / By Som Chaudhuri

Som Chaudhuri

Coding Secrets that You Need to Know

The pragmatic trillion dollar U.S. healthcare industry is heavily affected by inaccuracies and erroneous billing and coding. To curtail the enormous threat, healthcare service providers established their foothold to cater to the entire industry through motley campaigns and creating awareness.

In the recent past, the transition from ICD-9 to ICD-10 equipped medical coding with enhanced arms and took it to the next level of efficiency. The changeover came into action to avoid costly delays or penalties with better detailing to clinical diagnoses, creating a multitude of new codes to be implemented. Be it a physician’s clinic or hospitals, in-house coders’ fails to sum up the entire claims processing and it results in denial or rejection.

To overcome these shortcomings outsourcing of medical coding shows a silver lining and elevates reimbursement rates.  The service has both professional and technical components and modifiers are two digit codes appended by CPT.

Let’s divulge some of the secrets of medical coding:

~ The medical insurance provider always receives a bill that contains Current Procedural Terminology (CPT code). If a coder mistook or represents a bill without proper CPT codes, the entire system may go haywire.

~ CPT modifiers are added to the end of a CPT code with a hyphen. In the case of more than one modifier, you code the “functional” modifier first, and the “informational” modifier second. The distinction between the two is simple: you always want to list the modifiers that most directly affect the reimbursement process first.

~ Similarly, a CPT modifier may describe whether multiple procedures were performed, why that procedure was necessary, where the procedure was performed on the body, how many surgeons worked on the patient, and lots of other information that may be critical to a claim’s status with the insurance payor.

Coding accuracy counts. Let’s glance on some important pointers:

~ Coding is extraordinarily detail-oriented work. The coder must carefully review the patient’s chart to learn the diagnosis and include every service that was provided.

~ Codes change constantly, so medical coders must keep abreast of new rules and interpretations.

~ A solid understanding of medical terminology, including anatomy, is also required.

~ A certified professional coder (CPC), a designation that demonstrates to potential employers a certain level of coding skill and accuracy.

~ The coder must also understand private payer policies and government regulations for accurate coding and billing.


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