Medical coders are the conduit between Physicians and Insurance companies, translating the complex, sensitive medical data into meaningful standardized codes that are simple and effective in understanding the condition of the patient, diagnosis done and procedures executed to remediate the condition. With about 20 years of experience in medical Coding industry, we are one of the important nexus to reckon with.
The skill and expertise our AAPC Certified coders bring to the table adds enormous value to the revenue cycle management of the practice and to the very clinical documentation. We understand the sensitivity and seriousness of the work we do and you can stay rest assured of the fact that you and your patients are in safe, professional hands.
Though the Procedure codes are common between all the payors, there are a lot of intrinsic details about applying the right modifiers to the right set of codes. Some Procedures are not even covered by Medicare and some need Prior authorization and some will be bundled, and some needs a modifier to instruct that it is not bundled and is a separate procedure.
Our AAPC certified coders not only have the knowledge of Diagnosis(ICD) and Procedures(CPT), but are well versed with the Payor and state rules to optimize the reimbursements.
Our Coders do pay attention to CCI and make sure the practices level code and do maintain appropriate documentation for the level of codes selected.
Academics of Medical Coding
A medical report from a doctor contains details of patient’s condition, doctor’s diagnosis, prescription and whatever procedures performed by the doctor or health care provider on the patient. The coder turns the details into a set of codes, which remains the crucial source for insurance claim. This coding system allows efficient transfer of huge amount of data to the insurance companies, making their life easier. Uniformity in the codes not only improves the efficacy of the insurance companies but provides a valuable platform for pragmatic research and analysis of data by government health agencies, which helps them track the health trend effectively.
3 types of codes
ICD – International Classification of Diseases is established by WHO in 1940s. This code goes through modification, and the current code in vogue is ICD-10-CM, where 10 stands for 10th revision and CM stands for Clinical Modification. There are about 68000 codes in this version.
CPT – Current Procedure Terminology is the set of code established by AMA (American Medical Association), which is copy righted, and modified each year by AMA. There are three categories of CPT codes, out of which first one is mandatory, second one is optional, but provides detailed interpretation of diagnosis, and third category corresponds to emerging medical technologies.
HCPCS – Healthcare Common Procedure Coding System is a set of codes that are based upon CPT codes, again established by AMA. HCPS primarily corresponds to services, procedures and equipment not covered by CPT codes. HCPS is the official code for outpatient hospital care, chemotherapy drugs, Medicaid and Medicare, among other services.
A medical coder provides the details of symptoms (as outlined by ICD code) with which the patient approached the service provider, and the service provided (as outlined by CPT code) by the service provider.
ICD-10-CM range and topic
|A00-B99||Certain infections and parasitic diseases|
|D50-D89||Diseases of the blood and blood-forming organs and certain disorders involving the immune mechanism|
|E00-E89||Endocrine, nutritional and metabolic diseases|
|F01-F99||Mental, Behavioral and Neurodevelopmental disorders|
|G00-G99||Diseases of the nervous system|
|H00-H59||Diseases of the eye and adnexa|
|H60-H95||Diseases of the ear and mastoid process|
|I00-I99||Diseases of the circulatory system|
|J00-J99||Diseases of the respiratory system|
|K00-K95||Diseases of the digestive system|
|L00-L99||Diseases of the skin and subcutaneous tissue|
|M00-M99||Diseases of the musculoskeletal system and connective tissue|
|N00-N99||Diseases of the genitourinary system|
|O00- O9A||Pregnancy, childbirth, and puerperium|
|P00-P96||Certain conditions originating in the perinatal period|
|Q00-Q99||Congenital malformations, deformations and chromosomal abnormalities|
|R00-R99||Symptoms, signs, and abnormal clinical laboratory findings, not elsewhere classified|
|S00-T88||Injury, poisoning, and certain other consequences of external causes|
|V00-Y99||External causes of morbidity|
|Z00-Z99||Factors influencing health status and contact with health services|
The six sections of the CPT codebook are,
- Valuation and Management: 99201 – 99499
- Anesthesia: 00100 – 01999; 99100 – 99140
- Surgery: 10021 – 69990
- Radiology: 70010 – 79999
- Pathology and Laboratory: 80047 – 89398
- Medicine: 90281 – 99199; 99500 – 99607