Medical coding has witnessed significant changes over the past 20 years. This article highlights the advancements in medical coding and their advantages.

1. PAST
PRESENT
FUTURE
MEDICAL
CODING
INDUSTRY

2. Medical Coding Industry – Past Present and Future
Medical coding which is an integral part of the medical billing and claims processing
process has witnessed significant changes over the past 20 years. The eighties were
a period when medical records were mostly handwritten, typed or transcribed. With
the entry of computers, these machines were used to type medical documents that
were stored on floppy disks or printed out using dot-matrix printers.
There were no specially trained medical coders and the coding was done via a
superbill or chargemaster marked by the physician. The processing of claims was
rather cumbersome because the procedures and services had to be entered into
computer software billing systems, the claims printed and mailed to the payers.
Patient payments and insurance payments were received via snail mail. These had to
be entered into the same software program; monthly statements recording a
patient’s balance had to be printed out and mailed.
As the technology expanded to computers, electronic health records began to replace
paper charts and specialized software programs were developed to meet the
administrative requirements of the medical office. In addition to that, healthcare data
began to be quickly transmitted electronically via the internet. With technological
revolution in the healthcare field, the coding process has become easy for coders as
they can access the right information really fast.
Online data transfer however involves the risk of unauthorized access to patient
healthcare information. In addition to stringent HIPAA laws, healthcare providers,
insurance companies and government agencies have established additional computer
system requirements for the secure handling of online healthcare data.
Most Common Code Sets Now In Use
•
CPT – In 1966, the American Medical Association (AMA) published this code
set to describe medical, surgical and diagnostic services accurately. They are
alphanumeric, five digit codes which include Category I codes (to describe a
procedure or service), Category II codes (used for performance
measurement) and Category III codes (temporary codes for new and
emerging developments).
•
HCPCS Level II – These are five-digit alphanumeric codes which represent
durable medical goods, medical supplies, non-physician services (for example,
durable medical equipment, prosthetics, orthotics) and other services not
included in the HCPCS Level I or CPT codes. This is used as an official code
set for outpatient hospital care and chemotherapy drugs. This coding system
was released by the federal government in the 1970s.
•
ICD-9 – International Classification of
Diseases, Injuries, and Causes of Death
(ICD), the global classification system for
disease and mortality was adopted by the
World Health Organization in the middle of
the twentieth century. ICD-9-CM (Clinically
Modified) was adopted by the U.S in 1979. It
is the standardized code set for diagnostic
and inpatient hospital coding and should be

3. used for medical claim billing. This coding manual includes Volume 1
(numeric listing of diseases classified by etiology and anatomical system,
another classification of other reasons for encounters and causes of injury),
Volume 2 (alphabetic index to locate Volume 1 codes) and Volume 3
(procedural classification).
Medical coding systems now cover disabilities, prescription drugs, mental health and
the dental field. With increase in the complexity of coding systems, specially trained
medical coders have become indispensable. AAPC (American Association of
Professional Coders) certified medical coders are well-trained in all the code systems
and can ensure accurate medical coding and clean claims.
Medical Coding Has Become Easier with Advanced Technology
Instead of manual coding using the voluminous ICD-9CM diagnostic and CPT procedural coding manuals,
medical coding can now be carried out using encoding
software programs. The software allows a simple
search of specific terms to get accurate codes faster
and efficiently. It can analyze the digitized medical
records to assign appropriate codes, validate the codes
and ensure final submission to clients through webbased repository. This can definitely increase the
coding efficiency. However, the service of an
experienced, AAPC (American Academy of Professional
Coders) certified medical coding specialist is still
vital for reducing coding mistakes and ensuring proper
reimbursement for providers.
Future of Medical Coding
The largest change coming to the U.S. healthcare industry
is the replacement of ICD-9-CM
codes with ICD-10 codes. The U.S. Department of Health
and Human Services (HHS) has mandated that medical
coders and billers use ICD-10 codes for reporting health
are diagnoses and procedures from October 1, 2014. ICD10 includes more detailed codes to specify the exact
condition so that the medical coders require a greater knowledge about anatomy and
organ systems to assign accurate codes. For example, it uses combination codes to
specify two diagnoses, a diagnosis with an associated secondary process or
manifestation; and a diagnosis with an associated complication. The codes are
expanded for:
• Conditions and common symptoms or manifestations
Example - K50.112 (Crohn’s disease of large intestine (condition) with
intestinal obstruction (manifestation))
• Poisonings and external causes
Example - T36.0x1D (Poisoning by penicillin’s (poisoning), accidental
(unintentional), subsequent encounter (external causes))

4. Medical necessity is regarded as a prime requirement by most of the insurance
companies, especially Medicare and Medicaid, to pay medical expenses. The preauthorization process requires the provider to prove via medical documentation that
a particular service/procedure is medically necessary. With ICD-10 codes affording
more specificity in medical coding, medical necessity can be more easily proven.
Physicians can always go for the services of a professional medical billing and
coding company that provides reliable medical coding services and benefit from
efficient medical coding services from experienced medical coders.
About Outsource Strategies International
Outsource Strategies International, a leading medical coding company offers
comprehensive medical coding services for medical groups, hospitals, ambulatory
surgery centers, and coding companies throughout the United States. Take
advantage of our Free Medical Coding Trial today! Send us up to 10 charts and let
our certified coders (AAPC) code them for you for free. To learn more about our
medical coding outsourcing services, call 1-800-670-2809.