Medical Coding Services Overview

Accurate Medical coding is a critical factor in obtaining reimbursements from Payers as well as maintaining patient records. Coding claims accurately let the insurance payer know the illness or injury of the patient and the method of treatment and enables them to adjudicate claims correctly.

Overview of Medical Coding Systems and Standards

 Medical coding can involve one or more of the following types of codes: ICD codes, CPT codes, HCPCS codes, DRG codes, and modifiers. All of these coding sets are important for communication and billing purposes. Not only is coding important for capture of details of diseases and creation of medical records but is also important for getting reimbursements from commercial payers as well as Medicare and Medicaid.

Ascribe Healthcare operates a coding center of excellence with certified coders who are proficient in multiple types of medical codes including:

• ICD Codes. The International Statistical Classification of Diseases or ICD codes is specific to classifications of diagnoses, symptoms, and causes of death in humans. The World Health Organization creates, copyrights, and oversees these classifications. These codes are a global standard and are recognized by every medical facility and practitioner worldwide.

• CPT Codes. CPT codes or Common Procedure Terminology is defined for every medical procedure and are maintained by the American Medical Association

• HCPCS Codes. The HCPCS (Healthcare Common Procedure Coding System) levels I and II is another coding system. HCPCS codes are defined in three levels. Level I is comprised of CPT codes, and Level II includes alphanumeric codes that are used to identify products, supplies, and services not included in the CPT codes when used outside a physician's office.

  • Level I CPT (Current Procedural Terminology) codes are made up of 5 digit numbers. These Codes are managed by the American Medical Association (AMA). CPT codes are used to identify medical services and procedures ordered by physicians or other licensed professionals.

  • Level II HCPCS are alphanumeric codes consisting of one alphabetical letter followed by four numbers. These codes are managed by The Centers for Medicare and Medicaid Services (CMS). These codes identify non-physician services such as ambulance services, durable medical equipment, and pharmacy.

  • Level III HCPCS codes are alphanumeric codes W, X, Y, or Z followed by a four-digit numeric code. These are known as local codes, these codes are used as a miscellaneous code when there is no level I or level II code to identify it.

• Modifiers. Modifiers, a two-digit character set - two numbers, two-letter, or alphanumeric characters, that provide additional information along with HCPCS Codes. These are often to identify the area of the body where a procedure was performed, multiple procedures performed in the same session, or indicate a procedure was started but discontinued.

• DRG Codes. Diagnosis-Related Grouping (DRG) codes are used for coding of inpatient claims. The DRG codes define the accuracy of all the inpatient service components used by the facility. As these groupings are logical, most insurance companies pay according to the DRG used and, therefore, critical for inpatient facilities to obtain proper reimbursements.