The U.S. healthcare system depends on accurate information being communicated between patients, healthcare providers, clinics, hospitals, and insurance companies. To ensure that medical bills represent the precise care that patients actually receive, the healthcare system relies upon medical coding specialists to interpret diagnostic information and procedures provided by medical personnel. Coding specialists then convert this data into universally-recognized codes using the ICD-9 & ICD-10 CPT systems, so that medical billing specialists can provide information to insurance companies for payment.
Medical coding requires the skills to interpret and translate written descriptions of diseases, injuries, conditions, and medical procedures into established classifications set up by the World Health Organization (WHO) and the American Medical Association (AMA).
The codes used by medical coding specialists are standardized across healthcare services to provide information for the reimbursement of insurance claims, to collect statistics for research, and to track patient care. To develop a mastery of coding, medical coding students will learn about:
anatomy and physiology (the study of living systems).
basic pharmacology (the study of the therapeutic use of medicine).
the ICD-9 & ICD-10 coding systems devised by the WHO.
the CPT coding system developed by the AMA.
spreadsheets, database management, and specialized coding software.
finance and medical billing procedures.
The Differences Between Medical Billing and Medical Coding
The tasks assigned to medical billers and medical coders in hospitals, clinics, and healthcare organizations are closely related. These tasks may be performed by a single person with extensive knowledge of both fields, or there may be different people handling the various stages of documentation, research, and billing.
While medical billing specialists focus on collecting payments from patients and insurance companies, medical coding specialists translate medical, diagnostic, and injury-related information from medical professionals into appropriate codes. They use the ICD-9 and ICD-10 systems and CPT codes that refer to all medical procedures and diagnostics to complete claims with accurate information.
Become a CPC by Taking the AAPC Examination
In order to become a medical coding specialist, you need to pass the American Academy of Professional Coders (AAPC) exam to become a Certified Professional Coder (CPC). The AAPC offers the following certifications in coding:
Certified Professional Coder (CPC)
Certified Professional Coder – Outpatient Hospital (CPC-H)
Certified Professional Coder – Payer (CPC-P)
You can compare the different types of medical coding certifications on the AAPC site.
Prepare For the CPC Exam
The CPC exam includes questions on:
the CPT system, including an understanding of different medical procedures and treatments in detail.
the ICD-9 system.
the Healthcare Common Procedure Coding System (HCPCS) Level II.
the processes involved in anesthesia and radiology.
lab work and pathology that requires knowledge of chemistry, disease panels, and other forms of medical testing.
medicine, medical terminology, and anatomy.
coding procedures and guidelines.
coding regulations and compliance.
The AAPC has even more information on the topics tested on the certification exam.
FAQ About Medical Coding
Q: Do I need a degree to become a medical coding specialist?
A: A degree is not required when pursuing certification as a medical coding specialist. However, an associates or bachelor’s degree in science or medical technology can assist with the examination preparations. College degrees in these areas will likely open up additional career opportunities in the field.
Q: How important is certification?
A: Most jobs in medical coding require one of the certifications offered by the AAPC.
Q: How can I advance in my career?
A: With experience in medical coding, you can look for opportunities in health care management and administration. You might also consider a degree in science, business, or health care administration.
Q: Do I need to be certified for both medical billing and coding?
A: Though not necessary for a career in the medical coding field, certification in both fields will open up more potential job opportunities
Q: Does CPB certification allow me to start my own business?
A: Yes, once you have your certification you can either work for a healthcare provider directly or open your own practice and contract with hospitals or individual providers.
Having the best and most up-to-date Electronic Medical Records (EMR) software will significantly ease the ICD-10 transition, allowing for better familiarity, faster adoption, and less disruption in cash flow after the deadline. Specific EMR features and functionalities exist within these software systems that can assist healthcare providers with ICD-10-CM as they train and integrate these codes into their specialty-specific practice. Here are four must-have, key EMR features to look for when purchasing or updating their software to fulfill ICD-10 and Meaningful Use requirements.
1. EMR clinical documentation templates
Since ICD-10-CM is characterized by a much higher level of detail, physicians need to capture medical data that matches ICD-10-CM’s specificity. Clinical documentation for each medical encounter doesn’t have to increase in volume, but it does need to increase in precision (e.g. laterality, comorbidity, anatomic location, etc.).
EMR templates help physicians incorporate all necessary elements for proper ICD-10 clinical documentation in a clear, organized, and structured manner. Another crucial advantage is that EMR templates can be used to remind physicians to ask patients specific questions for documentation purposes. Having correct and complete patient data to enter into the documentation template will expedite the process of finding the appropriate ICD-10 code for the medical diagnosis and treatment. Customized templates are available for various kinds of patients and medical services.
2. ICD-10 code search interface
Standard, updated EMR software should have an intuitive, easily navigable interface that makes it possible for healthcare professionals (end users) to input a word, term, or phrase and receive a list of matching ICD-10 codes. This interface will come with guides that will tell you if the correct ICD-10-CM code has been selected or if further steps need to be taken to find the right ICD-10-CM code.
3. ICD-10 side-by-side code tool
This EMR functionality is an excellent training tool as physician practices transition to ICD-10. After a physician or coder enters in a medical keyword or phrase, the ICD-10-CM side-by-side feature will display the relevant ICD-9 codes on the left side and ICD-10 codes on the right side so the healthcare professional can compare both code sets for a particular diagnosis, treatment, and so on.
For example, a physician enters in “nasal fracture” as a search term. Two ICD-9 codes come up for this injury:
- 802.0 Close fracture of nasal bones
- 802.1 Open fracture of nasal bones.
Seven ICD-10 codes come up for the same search term, some of which are:
- S02.2XXG Fracture of nasal bones subsequent encounter for fracture with delayed healing
- S02.2XXK Fracture of nasal bones subsequent encounter for fracture with nonunion
- S02.2XXS Fracture of nasal bones sequela
Healthcare professionals would facilitate their familiarization and adjustment to ICD-10-CM codes by utilizing this side-by-side coding capability while coding in ICD-9 for now.
4. ICD-10 General Equivalency Mappings (GEMs)
Similar to ICD-10 side-by-side coding tools, GEMs will display matching, or equivalent, ICD-10-CM codes when one inputs an ICD-9-CM code. It works in reverse too. When a physician enters an ICD-10-CM code, the GEM will list the matching ICD-9-CM codes. A GEM translates medical codes bi-directionally, but it can’t be used as a short-cut to regular ICD-10 training measures.
ICD-9-CM and ICD-10-CM aren’t equivalent in every aspect of their coding systems. ICD-9 has some codes that ICD-10 doesn’t have, and ICD-10 has a vast number of codes that ICD-9 doesn’t have. Medical concepts incorporated into ICD-10 may be non-existent in ICD-9, and vice-versa. Therefore physicians can’t rely solely on side-by-side coding and GEM capabilities. They were designed in part to supplement the medical professional’s coursework and ICD-10 books as they relate to the medical professional’s specialty.
Having an EMR solution with these four key features can help eliminate the stress of transitioning to ICD-10. If you are looking implement an EHR for the first time, or if you are looking to make a switch, make sure you give yourself ample time to be up and running and to have all staff properly trained on the system before the October 1, 2015 deadline.