Medical Coder And Combination Codes

Using the expertise of a certified medical coder ensures your claims are paid on the first submission, resulting in faster reimbursement.
The primary responsibilities of the medical biller and medical coder are billing for the services rendered by a healthcare provider. While these disciplines are highly dependant on each other, their job functions are very different.
The primary responsibility of the medical biller is making sure the healthcare providers get paid for their services.
The primary responsibility of the medical coder is coding claims accurately for submission to insurance payers.
The U.S. Department of Labor predicts growth of more than 20% in the field between 2008 and 2018 (the last estimates available). This means over 35,000
new medical billing and coding jobs will be created.

The Role of the Medical Coder
Medical coders are specialists who interpret medical reports written by physicians and other healthcare providers into simple medical and descriptive terms for billing purposes. It’s imperative that the medical coder interprets the medical report accurately to ensure the insurance payers understand the claim so that it won’t be rejected.

Some medical coders specialize in coding anesthesia, cardiology, interventional, emergency, hospital, or physician based claims. According to American Academy of Professional Coders (AAPC), the requirements of a medical coder are:
Proficiency in adjudicating claims for accurate medical coding for diagnoses, procedures and services in physician-based settings
Proficiency across a wide range of services, which include evaluation and management, anesthesia, surgical services, radiology, pathology and medicine
Sound knowledge of medical coding rules and regulations including compliance and reimbursement. A trained medical coding professional can better handle issues such as medical necessity, claims denials, bundling issues and charge capture
Knowing how to integrate medical coding and reimbursement rule changes into a practice's reimbursement processes
Knowledge of anatomy, physiology and medical terminology necessary to correctly code provider diagnosis and services
The medical coder uses a system of alpha numeric codes used either nationally or internationally in the health profession to designate various aspects of the medical process, which includes:
Checking a variety of sources within the patient’s medical record, including the transcription of the physician’s notes, ordered laboratory tests, requested imaging studies and other sources, to verify the work that was performed.
Having a thorough knowledge of anatomy and medical terminology is essential. It is also important that the medical coder is familiar with different types of insurance plans, regulations and, of course, CPT®, HCPCS Level II and ICD-9-CM codes and guidelines. This knowledge enables the medical coder to assign correct codes and service levels for the procedures performed and supplies used to treat the patient and to properly identify the physician’s diagnoses.
Compare and contrast ICD9 and ICD10, giving specific details.

Number of Codes
As part of the effort to provide more information, ICD-10 will have roughly 68,000 available codes (with flexibility for adding new ones) in comparison to ICD-9's 13,000 codes and limited space for additions. Codes may be somewhat different than before, so coders will need to understand how to effectively search for codes under the new system.
Length of Code
ICD-10 uses codes that are longer (in some cases) than those of ICD-9, following a basic structure.
Digits 1-3 will now refer to the category
Digit 1 is always alphabetic
Digits 2-3 are always numeric
Digits 4-6 will cover clinical details such as severity, etiology, and anatomic site (among others), and are either alphabetic or numeric
Digit 7 will serve as an extension when necessary, and will be either alphabetic or numeric
Combination Codes
ICD-10 supports further use of combination codes that can be used to classify such things as multiple diagnoses or a diagnosis with a complication. These are expressed as single codes, reducing the number of codes that need to be made while still providing information that is as specific as possible.
Use of Alphabetic Codes
ICD-9 only permitted numeric codes. In contrast, ICD-10 will make significant use of alphabet codes as part of its work to be more specific. The characters will not be case sensitive, and both alphabetic and numeric codes are intended to retain identical meanings as much as possible throughout code sets and procedure
sections.
The additional characters allow for information such as listing the body system, root operation, body part, approach, device, and any necessary qualifier all within one code for a surgical procedure. Use of this may vary somewhat by section.
Relevance to Modern Technology
ICD-9 is widely considered to be based on outdated technology, with codes unable to reflect the use of new equipment.
ICD-10 offers far more integration with modern technology, with an emphasis on devices that are actually being used for various procedures. The additional spaces available are partly designed to allow for new technology to be seamlessly integrated into codes, which means fewer concerns about the ability to accurately report information as time goes on.
In Conclusion
ICD-10 is not a simple update to ICD-9. The structural changes throughout the entire coding system are very significant, and the increased level of complexity requires coders to be even more thoroughly trained than before. However, it is possible to prepare for the changes by remembering a few simple guidelines:
Train early- The more familiar your staff are with ICD-10, the better. While currently scheduled to begin Oct. 1, 2014, beginning the training now is not a bad idea.
Understand the ICD-10- The structural changes require a change in the way people think about coding, and understanding it will help to break current coding habits. Medical professionals used to reporting things a certain way so they can be coded may need to change what they say in order to work well with the new system.
Ask for help- If there is something you or your staff need help with or do not understand, ask for
help.