What is Medical Coding

Medical Coding is all about determining what services are provided and what the charge for the service is hooked to the service. Every healthcare provider that delivers a service receives money for these services by filing a claim with the patient's health insurance provider or managed care organization. This is also referred to as an encounter. An encounter is defined as "a face-to-face contact between a health care professional and an eligible beneficiary."

Medical Coding

Codes exist for all types of encounters, services, tests, treatments, and procedures provided in a medical office, clinic, or hospital. Even patient complaints such as headache, upset stomach, etc., have codes which consist of a set of numbers and combinations of sets of numbers. The combination of these codes tells the payer (health insurance companies or government entities) what was wrong with the patient and what services were performed. This makes it easier to handle these claims and to identify the provider on a predetermined basis. In addition, the services rendered (CPT) codes have to match the diagnosis (ICD) codes to justify medical necessity.
To do this correctly for each third party payer choices have to be made from a combination of 3 coding systems totaling over 10000 codes, and which change annually. In addition, a completely new coding system, ICD-10, is proposed for reimbursement purposes in the near future.