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A Quick Medical Coding Story

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Meditech Medical Coding Training School has lots of coding training experience. Medical Coding developed after the 1960s. Earlier, no real uniform methods of using ICD or CPT codes was enforced. Gradually, a system of numbers (the codes now used) to describe various problems and treatments. The treatment codes, Current Procedural Terminology (CPT-4). The International Classifications of Diseases (ICD-9 codes) are used for problems (diagnoses). The government then got involved and developed their own codes, called "HCPCS," (Healthcare Common Procedure Coding System). The HCPCS go a step further to allow alphanumeric codes assigned to drugs, medical devices, etc., to allow even more detail for a payer to review and make more logical determinations for payment. So both medical coding and medical billing employ those code systems. The Meditech medical coding-billing training teaches how to use the codes.

Let's illustrate coding with an medical coding example. A hospital summary or chart arrives on the desk of a coder who will abstract the following information, convert it to code and either data enter it or send it to data entry:

    ER visit:
    11 year-old male fell from a horse and sustained a broken leg
    X-ray revaled an acute femur fracture 17 cm above patella
    Procedure: Open reduction, internal fixation and cast application
    Followup: 3 week FU with Dr. Marrow

From this simple note, several items may be identified, described and charged (ICD, CPT and HCPCs codes). Let's explore a little further. We look at the visit details and discover that a child has fallen from a horse and has broken his leg, which is the "problem," (diagnosis). He came to the emergency room and was seen by an ER doctor. The doctor sends the child off for x-rays. X-rays show an open transcervical fracture of the femur, which is the diagnosis (more definitive than the "acute femur fracture" in the note). The fracture was repaired with a procedure called an "open reduction internal fixation (ORIF)." When this is complete, the doctor places a cast.

The relevant coding from the above will result in a printed bill and/or insurance claim would look something like this when coded:
    X-ray acute femur fx 17 cm above patella 820.12 / E828.2 (diagnosis codes)
    ORIF & cast 99284 / 27506 / 29345 / 73550 (CPT codes)

When the insurance form is printed (and in the statement), the diagnosis would appear in the diagnosis input field as:
    820.12 Transcervical Fracture, Open [and] E828.2 Accident, Horse

820.12 translated = 820 is femur fracture, the .1 means it is an open fracture, and the 2 notes it is the midcervical section of the femur. The E828.2 is a code describing how it happened. The 828 tells the payer that it was a result of an "animal ridden," and the .2 tells that the patient was the rider.

The 99284, 27236, 29345 and 73550 are all CPT codes describing the service to the patient.

The information on the claim or bill would appear something like this:

SERVICE DESCRIPTION DIAGNOSIS AMOUNT
99284 ER detailed exam 820.12, E828.2 100
27236 ORIF 820.12 400
29345 Cast 820.12 150
73550 X-ray femur - 2 views 820.12 100

For billing purposes, the use of the ICD codes, when juxtaposed to CPT codes, tells the payer not only what service has been provided but also lists the diagnosis, symptom, complaint, condition or problem (e.g., the reason for performing the service). The codes thus help establish the medical necessity as the first step in third party reimbursement.

The coder determines the codes to be used following each patient encounter. The reviewer/auditor must determine if the coder has in fact used the appropriate codes.

With this specialized training and expertise coders find work any place, any time, any where! In large medical record departments, experienced medical record coders may function as section supervisors, overseeing the work of the coding, correspondence, or discharge sections, for example. Eventually, experienced medical record coders and health insurance specialist-billers may advance to senior technicians who specialize in coding, particularly Medicare coding, or in tumor registry.

Coding (and even billing) training of medical coders and insurance specialists has a traditionally required from two to four years of college. Fortunately, this career training course is now available from Meditech as an online or an eBook course.

National organizations and associations for Health Insurance Specialists, Billers and Coders are available for the future certification processes. Meditech certifies course completion often sufficient to get a healthcare job. Otherwise, certification is available from various sources, e.g., Medical Certification Coding-Billing Certification
Meditech Coding-Training.com Site Links:
  • Main Coding Resources Page
  • Case Studies
  • Category II Codes
  • Chart Notes [SOAP & SNOCAMP]
  • Coding From Home
  • CPT Codes
  • HCPCS Codes
  • HIPAA Privacy Act
  • Medical Coding FAQs



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    Monday, 11-Apr-2011 15:08:24 MDT