Medical Coding
Over a period of time the medical industry faced increasingly sophisticated and complex procedures in the science of medicine. Improvements and refinements in these procedures were constantly developed and utilized, but physicians, in their statements for professional services, found it difficult to explain, the differences and refinements in procedures and to distinguish one procedure from another. Some providers furnished the same description for different services while others furnished different descriptions for the same services. The resulting confusion and uncertainty led to delayed or inequitable payments, creating dissatisfaction among consumers, payers and physicians themselves.
Added to this, the growing involvement of computers made it apparent that some method had to be devised to describe the enormous numbers and kinds of medical and surgical procedures, complaints and diagnoses, so that a code number can be assigned to them to facilitate accurate and rapid determination of the nature and value of the service performed. Following the theory that “necessity is the mother of invention”, this is where the medical coding system evolved.
Two types of coding systems have thus evolved: the first is Current Procedural Terminology (CPT) and the second is International Classifications of Diseases (ICD).
What is the Coding Process
In a few simple points, the Coding Process is as follows: Here is the breakdown.
1. Pre-coding of the charge tickets.
2. Coding of the Diagnosis and the Procedure with reference to the above materials.
3. Checking the compatibility of the diagnosis with the procedure code
4. Checking for the modifiers in relation to the procedure.
5. Cross checking all the codes with the original check list.
6. Sending the file for QC (Quality Control) analysis.
7. The quality control re-checks the following:
a) Coding b) Pre-coding with all the references available.
8. QA (Quality Audit) is done again to give a 100% quality to the file.
9. Clarifications and doubts are noted and register it as document and sent to the client for confirmation.
10. TC (Teleconference) with the clients is conducted (if available) to get the updating and clarifications cleared – with prior schedules.
Proskribe ensures that all these processes take place under the supervision of Certified Medical Coders. We ensure the deliverability of all the processes that we undertake.