Basics of Medical Billing and Coding in United States

Medical billing and coding is used in united states, in order to make the claim procedure easy for the patients. It is especially helpful if a patient has any medical exam. A medical office works usually with the patient and the patient's insurance company for claims. The biller will submit and follow up on any claims in order to receive payment for services rendered by the health care provider.

Medical billing and coding workers are the health care professional. They are in charge of processing patient data such as treatment records and related insurance information. Main tasks of medical insurance billers and coders are to code patient's diagnosis along with a request for payments from the patient's insurance company. The workers usually have to learn many codes, each one representing a symptom, medications and diagnoses. Only than they are able to process the claim properly.

International Classification of Diseases, also known as ICD, the 10th revision of the International Statistical Classification of Diseases and Related Health Problems. It is an integral part of billing and coding system. In other words, it is a common language that compiles, reports and uses health care information. It is periodically upgraded by the World Health Organization (WHO).This is the reporting system for morbidity statistics and mortality status.

Medical Billing and Coding profession

The health care industry of united states largely depends on skilled, qualified medical insurance billers and coders. Because it is vital that each patient's account is record, register and track accurately. Although the medical coder and biller often work together to make sure all invoices are paid properly, but this procedure requires two distinct professionals i.e. Medical biller and medical coder.

Medical billers are basically responsible for that everyone is being billed correctly. It involves talking with patients as well as with health insurance companies on a regular basis. Communication with both parties is vital to make sure that all invoices are paid on time. The competence of biller depends that how good he understand coding language and read medical invoices.

On the other hand, medical coders job don't involve too much interaction with insurance companies and patients. A medical coder has to spend time assessing as well as coding data. Every duty performed in a medical office has a particular code assigned to it and here is a job of coder because every code needs to be coded properly. Some smaller medical offices might have one employee handle both job functions, but many times these jobs are outsourced to a medical billing service that can handle both jobs.

CPT Procedure Codes

The CPT coding system is there to provide the doctors a uniform process for coding medical services, across the country. This system streamlines reporting and increases accuracy and efficiency. Physicians and other healthcare professionals have relied on CPT for more than four decades. Due to this system, they can easily communicate with colleagues, patients, hospitals and insurers about the procedures they have performed.

HCPCS Codes

The numbers, that Medicare assigns to every task and service, are known as HCPCS codes. HCPCS stands for Healthcare Common Procedure Coding System. These codes are used by Medicare and monitored by CMS, the Centers for Medicare and Medicaid Services.

They are based on the Current Procedural Technology codes, shortly known as CPT codes. They are developed and updated by the American Medical Association.

CPT Modifiers

As we all know that medical procedures and services are often complex. We sometimes need to supply additional information when we’re coding. But here we need help in order to understand that for what actually we asked for. CPT Modifiers are there to help us. These modifiers modifies the code in the English language, provide additional information about the procedure.

It can be said that a CPT modifier may describe whether multiple procedures were performed, why that procedure was necessary, where the procedure was performed on the body, how many surgeons worked on the patient, and lots of other information that may be critical while claiming with the insurance payer.

CPT Modifiers consist of two characters, can be numeric or alphanumeric. Mostly CPT modifiers are numeric, but there are also a few alphanumeric Anesthesia modifiers. CPT modifiers are usually added to the end of a CPT code with a hyphen. In case of more than one modifier, it is recommended to code the “functional” modifier first, and the “informational” modifier second.

Difference between ICD-9 and ICD-10 codes

ICD as discussed above, is a common language that compiles, reports and uses health care information. ICD-10 codes are alphanumeric. Unlike the codes in ICD-9, These new codes will require compatible billing software and will employ data that provide more information about a patient's condition.