Medical coding is the way in which procedures and diagnoses are classified by a coding shorthand to determine how sick someone is and what was done to fix it. Medical coding software makes that process easier.
our experience with medical coding software
Here are a few of our medical coding software projects
- Creating custom medical coding software to allow a coding service to manage pdfs from clients and code them easily.
- Creating the ability for an EMR to code visits using ICD-9 and CPT codes
Medical coding was once used as an internal measure for the medical providers; it is now used by healthcare providers to bill medical insurance companies and patients. The medical codes indicated by the healthcare provider determine what they will be paid for a procedure.
A medical diagnosis is what condition(s) the patient has. For example, a patient could be diagnosed with a fractured humerus (upper arm), as well as a fractured ulna (lower arm).
A medical procedure code is what action is performed on a patient. For example, putting a cast on a patient from their shoulder to their hand is a procedure.
Health Insurance providers have the benefit of being able to collect medical coding and billing data from many different sources. They use this medical billing and coding information to set rates for each procedure done; taking into account how difficult the procedure was to perform based on how sick the person was. This gives them power to evaluate the validity of the charges and to squeeze the best deal out of healthcare providers.
The United States has its own flavor of medical billing and coding systems. Currently, the typical medical billing and coding systems that are used in the United States are CPT codes and ICD-9-CM codes. CPT codes describe the medical procedures that were done. ICD-9-CM codes describe the patient’s diagnoses that were present at the time of treatment. In the United States, ICD-9-CM was created which adds a medical procedure section to the existing ICD-9 diagnoses and extends the list of diagnoses.
While ICD-10 is standard across the world as diagnosis codes, ICD-9 is currently the standard for diagnosis codes in the United States. The U.S. created additional diagnosis codes for ICD-9 and then named this modification ICD-9-CM.
ICD-9 uses 5 digit codes with a decimal to define conditions. For example, 008.61 means Enteritis (inflammation of the small intestine) caused by a rotavirus. ICD-9 contains approximately 13,000 codes, whereas ICD-10 contains over 120,000 codes. The reason why ICD-10 was created is that ICD-9 ran out of room to effectively code all of the disease conditions that exist.
ICD-10 codes add an alphanumeric character to the front of the ICD-9 codes, so that they consist of one alphanumeric character followed by 5 digits. Some of the additional space provided by ICD-10 is used to define new conditions, and some space is used to increase the specificity of existing conditions. For example, in ICD-9, fracture of the humerus is 812. In ICD-10, there are three possible diagnoses for fracture of the humerus.
- Sample – ICD-9
- 812 – Fracture of the humerus
- Sample – ICD-10
- S42.2 - Fracture of upper end of humerus
- S42.3 - Fracture of shaft of humerus
- S42.4 -Fracture of lower end of humerus
The US has also expanded ICD-10 with additional diagnoses and named this modification ICD-10-CM. ICD-10 is required to be implemented in 2011 in order to receive payment from Medicaid and Medicare.
CPT (Current Procedural Terminology) codes are the most common method of medical billing and coding in the United States to indicate which medical procedures have been performed. CPT codes were created & are managed by the American Medical Association (AMA). AMA owns and licenses the use of the CPT codes. CPT codes are required to be used to receive reimbursement from Medicaid or Medicare.
CPT codes are identified using 5 numeric digits. CPT codes only include procedures that are performed by or in the office of a physician.
HCPCS has two sections of codes that are currently in use - Level I and Level II.
Level I of the HCPCS is comprised of CPT codes (see above for more information).
Level II of the HCPCS is a standardized coding system that is used primarily to identify products, supplies, and services not included in the CPT codes, such as ambulance services and durable medical equipment, prosthetics, orthotics, and supplies (DMEPOS) when used outside a physician's office. Level II codes consist of a single alphabetical letter followed by 4 numeric digits, while CPT codes are identified using 5 numeric digits.
ICD-9-CM is an expanded version of the international standard ICD-9, created by the U.S. National Center for Health Statistics, which adds medical procedure codes (which are very similar to CPT codes). ICD-9-CM adds a Volume 3 to the standard. ICD-9-CM was created by the U.S. National Center for Health Statistics (NCHS) and is managed by NCHS as well as the U.S. Centers for Medicare and Medicaid Services. The ICD-9-CM procedure codes were created more as a method to track public health than as a reimbursement tool.
The U.S. added codes for medical procedures to ICD-10 and called that section ICD-10-PCS. Medical procedures were in the previous U.S. version of ICD-9 (ICD-9-CM), but used the same standard name as the diagnostic section. These two sections were named differently in ICD-10 to reduce confusion.
DRGs were created to provide an easier way to evaluate how complicated treating a particular patient would be. They are used by CMS for reimbursement calculations.