MEDICAL CODING

Speaker :
SOMNATH KUDE BSC(BIOTECH)

• CPC CERTIFIED MEDICAL CODER (2016)

• 8+ YEARS OF INDUSTRIAL EXPERIENCE

 DEFINITION OF MEDICAL CODING
• Medical coding is the process of assigning standardized codes to medical
procedures, diagnoses, and services. These codes are used for various
purposes, including billing, reimbursement, research, and quality assessment.
Medical coding translates complex medical terms and procedures into a
standardized format that can be easily understood and interpreted by
healthcare professionals, insurance companies, and other stakeholders in the
healthcare industry.
HISTORY OF MEDICAL CODING
• The history of medical coding can be traced back to the early 20 th century, when the use of
standardised classification systems for diseases and medical procedures began to gain
popularity. In 1900, the Bertillon Classification of Causes of Death was introduced, which
was used to classify and track mortality statistics.
. In 1910, the International Classification of Diseases (ICD) was introduced by the World
Health Organization (WHO) as a standardised system for coding diagnoses and diseases.
. In the 1960s, the American Medical Association (AMA) introduced the Current Procedural
Terminology (CPT) coding system, which was designed to standardise the coding of medical
procedures and services provided by physicians and other healthcare providers.
 MEDICAL CODING AND ITS IMPORTANCE
IN HEALTHCARE.
• Medical coding is a critical process in healthcare that involves the transformation
of complex medical procedures and diagnoses into a standardized code format.
These codes are used for many purposes, including billing, reimbursement,
research, and quality assessment.
• Medical coding is essential for the effective functioning of healthcare systems and
the delivery of quality patient care
 TYPES OF MEDICAL CODES
• There are two main types of medical codes: Current Procedural Terminology (CPT) codes and
International Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10-CM)
codes.
• CPT codes are used to describe medical procedures and services. These codes are created and
maintained by the American Medical Association (AMA) and are updated annually to reflect
changes in medical practice.
• ICD-10-CM codes are used to describe medical diagnoses and conditions. These codes are
maintained by the World Health Organization (WHO) and are used by healthcare providers and
insurance companies worldwide.
• Together, these two types of codes provide a comprehensive system for describing and
communicating medical procedures, diagnoses, and services in a standardized format.
CPT-CURRENT PROCEDURAL
TERMINOLOGY
• CPT codes consist of five digits, and each code represents a specific medical procedure or
service.
• CPT codes are organized into three categories: Category I, Category II, and Category III
codes.
• Category I codes are the most commonly used and describe medical procedures and services
that are widely performed
• Category II codes are used to report performance measures, while Category III codes are
temporary codes used to describe emerging technologies and procedures that do not yet have a
Category I code.
HERE ARE SOME EXAMPLES OF CPT
CODES AND HOW THEY ARE USED.
• 99213 – This code is used to describe a mid-level office visit with an established
patient. This might include a brief examination, review of medical history, and a
prescription refill.
• 45378 – This code is used to describe a colonoscopy procedure. This might include
the insertion of a flexible tube with a camera into the colon to examine the inside of
the colon for abnormalities or disease.
• CPT codes are used to describe a wide variety of medical procedures and services,
and they play a crucial role in the medical billing and reimbursement process.
 ICD-10-CM CODES -
• ICD-10-CM codes are a standardized set of codes used to describe medical diagnoses and
conditions. The codes were developed and are maintained by the World Health Organization
(WHO) and are used by healthcare providers and insurance companies worldwide.
• ICD-10-CM codes consist of alphanumeric characters and are up to seven digits in length.
• ICD-10-CM codes are organized into chapters based on the body system or condition being
described.
• ICD-10-CM codes are used by healthcare providers to document patient diagnoses in medical
records, and they are used by insurance companies to determine coverage and reimbursement
for medical services.
 HERE ARE SOME EXAMPLES OF ICD-10-CM
CODES AND HOW THEY ARE USED.
• J45.909 – This code is used to describe uncomplicated asthma. It is used by
healthcare providers to document the patient’s diagnosis in their medical
record, and it is used by insurance companies to determine coverage and
reimbursement for asthma-related medical services.
• E11.9 – This code is used to describe type 2 diabetes mellitus without
complications. It is used by healthcare providers to document the patient’s
diagnosis in their medical record, and it is used by insurance companies to
determine coverage and reimbursement for diabetes-related medical services.
MEDICAL CODING IS IMPORTANT FOR A
NUMBER OF REASONS.
• The importance of accurate medical coding in healthcare, such as ensuring
proper reimbursement, tracking disease patterns, and facilitating research.
• Medical coding is essential to the functioning of the healthcare system.
Accurate and consistent coding helps to ensure that patients receive
appropriate care, healthcare providers are properly reimbursed, and research
and public health initiatives are supported.
MEDICAL CODING GUIDELINES.
• Ensuring accurate and consistent coding
• Complying with legal and regulatory requirements
• Maximizing reimbursement
• Maintaining data integrity
• Coding guidelines such as those set by CMS is essential to ensure accurate
and consistent coding, comply with legal and regulatory requirements,
maximize reimbursement, and maintain data integrity.
THE RCM CYCLE OR REVENUE CYCLE
MANAGEMENT
• Encounter – Face to Face encounter with doctor
• Transcription- Converts the audio data in medical record
• Medical coding – Convert the whole medical record into Alfa- Numeric
codes
• Medical billing – Post the payment and charges of the given code to
insurance company
• AR – Denial management and watch on doctor collection.
MEDICAL RECORD DOCUMENTATION.
• Documentation provides the basis for coding
• Documentation must be specific
• Documentation must be timely
• Documentation must be consistent
TYPES OF MEDICAL RECORD
DOCUMENTATION.
• Progress notes.
• Operative reports
• Diagnostic test results
• Consultation notes
• Medication lists
• Accurate and complete documentation is essential for assigning accurate diagnosis
and procedure codes, which is critical for reimbursement, research, and patient care.
CODING ACCURACY
• Coding accuracy is critical in healthcare because it impacts not only reimbursement but also patient
care and legal compliance.
• Reimbursement
• Legal compliance
• Patient care
• Research
• Reputation
• It is essential for healthcare providers to prioritize coding accuracy and ensure that they have
processes and systems in place to prevent coding errors.
CHALLENGES OF MEDICAL CODING
• Medical coding can be challenging due to several factors.
• Changes in coding guidelines
• Complexity of medical procedures
• Specificity of codes
• Electronic health record (EHR) systems
• Billing and reimbursement
MEDICAL CODING CAREER
• Medical coding offers a variety of career opportunities, each with its own unique
responsibilities and requirements.
• Medical Coder
• Medical Biller
• Coding Auditor
• Coding Manager
• Medical coding offers a range of career opportunities, each with its own unique
responsibilities and requirements.
CONCLUSION
• Medical coding is an essential process in healthcare that involves translating medical
procedures and diagnoses into standardized codes.
• There are two primary types of medical codes: CPT codes, which are used to describe medical
procedures, and ICD-10-CM codes, which are used to describe diagnoses and conditions.
• Medical coding offers a variety of career opportunities, including medical coder, medical
biller, coding auditor, and coding manager.
• Inaccurate medical coding can have significant consequences, including incorrect
reimbursement and potential legal issues.
Question?
INTERVIEW QUESTIONS

• 1. What do you know about medical coding, and why did you choose to pursue a career
in this field?
• 2. What coding systems have you studied or worked with during your training or
education?
• 3. How do you ensure accuracy and compliance with coding guidelines?
• 4. How do you stay up to date with changes in coding regulations and guidelines?
• 5. Can you provide an example of a coding challenge you have faced during your
training, and how you resolved it?
INTERVIEW QUESTIONS

6. How do you prioritize your coding workload when faced with multiple tasks
and deadlines?

7. Have you had any experience with electronic health records (EHRs)? If so,
which ones?
• 8. How do you ensure patient confidentiality and privacy in your coding
work?
• 9. How do you handle conflicting information or missing documentation in
medical records?
• 10. How do you handle feedback and criticism in your work?
HUMAN ANATOMY AND PHYSIOLOGY
QUESTIONS

• What is the function of the gastrointestinal (GI) system?

• -The GI system is responsible for the digestion and absorption of nutrients, as
well as the elimination of waste from the body.
• What are the main organs of the GI system?
The main organs include the mouth, esophagus, stomach, small intestine
(duodenum, jejunum, ileum), large intestine (colon), rectum, and anus.
What are the primary functions of the stomach?

The stomach serves to store food, mix it with gastric juices, initiate protein digestion with
pepsin, and regulate the release of partially digested food (chyme) into the small intestine.

What is the role of the small intestine in digestion and absorption?

• The small intestine is where most of the digestion and absorption of nutrients occurs.
Enzymes from the pancreas and bile from the liver aid in the breakdown of
carbohydrates, proteins, and fats, while nutrients are absorbed through the intestinal
lining into the bloodstream.
What is the function of the large intestine?

The large intestine primarily absorbs water and electrolytes from the remaining
indigestible food material, forming feces for elimination.

What are common disorders of the GI system?

• Common disorders include gastroesophageal reflux disease (GERD), peptic
ulcers, inflammatory bowel disease (Crohn’s disease and ulcerative colitis),
irritable bowel syndrome (IBS), and colorectal cancer.
What is the cardiovascular system?

The cardiovascular system, also known as the circulatory system, is

responsible for circulating blood and transporting nutrients, oxygen, hormones,
and waste products throughout the body.

What are the main components of the cardiovascular system?

• The main components include the heart, blood vessels (arteries, veins, and
capillaries), and blood.
Thank you