Billing and Coding Essay

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The Use of Medical Code Sets
Adrianna Lopez
Charter College

Medical coding is a specialized profession within the wider field of healthcare administration. Medical coders review the documents within a patient’s medical records. They will then translate the written documentation into medical codes that are used throughout the medical field. These codes are used to submit claims to third party payers, and to gather information by keeping track of incidents of specific diseases. Accurate medical coding is essential to the healthcare industry and is used every day to ensure the most quality care for patients everywhere. The following information will explain each code set, ICD-9, CPT, and HCPCS codes, and what each is used for, as well as the importance. REF ReportTitle The Use of Medical Code Sets
Medical coding is the most commonly used procedure used to bill and organize a patients chart or medical record. There are thousands of different codes used throughout the coding system, and the importance of each one is unique. Each code means something different. The difference between a simple letter or number can mean a whole lot.
ICD-9 coding is also known as Diseases-9th Edition-Clinical Modification. The ICD-9-CM code set is divided into three volumes. The first two volumes are diagnosis codes and the third is procedure codes. Medical coders use the third volume often to code services that are usually provided in a hospital setting. The other two volumes are used to code medical billed claims. Depending on the situation, coders can assign codes at the time of service or can code based on the documents in their medical records. There are many people within the health care field that can code different procedures. It may be the actual billers and coders, it can be the physicians, or it can be the patient’s primary healthcare providers. It is also said that many health care providers do not normally code or receive coding training, so they rely on the medical billers and coders to do this job, which is important because these codes are critical to every medical record or billing process.
CPT coding, also known as Current Procedural Terminology, is the code set in which billed to medical insurers such as Medicaid, Medicare, and Tricare. It is used to code what procedures were used to diagnose or treat a patient. Most of the codes that are put into a medical record are used for this specific reason. To determine what was done to a patient, or what might be wrong with the patient, and what the treatment was or will be. Usually when a medical, diagnostic, or surgical procedure is performed, it is translated into CPT form. It is then reported to the third party payers for reimbursement. The training and understanding of this code set is again very important. There are so many codes to remember because it is usually the code set that is annually updated by the AMA (American Medical Association) and can have some changes after an update.
CMS is also known as Centers for Medicare and Medicaid Services. They are the ones who track the use of HCPCS codes. HCPCS is also known as Healthcare Common Procedural Coding System. It is also known to be used to identify products, supplies, and services not included in the CPT codes, such as ambulance services and durable medical equipment, prosthetics, orthotics, and supplies when used outside a physician's office. It is the main foundation of how claims are submitted to insurers and government healthcare programs. HCPCS are divided into two levels. Level 1 codes are based on the documentation used for CPT. HIPPA, the Healthcare…