Health Information Management (HIM) is both fascinating and often misunderstood. HIM is the art of medical coding which is a necessary step in billing and payment from insurance companies, Medicare, Medicaid, and patients.
Experience Matters
The CCMH HIM team includes Carmen Schuett, Ana Garcia Patino, Laura Gross, Dixie Janssen, and Tracy Kastner. Their task is creating accurate healthcare documentation and reimbursement at CCMH. Most of the HIM staff have been coding for extended periods of time. For instance, Kastner has been with CCMH for a remarkable 32-plus years.
Kastner’s longevity in medical coding underscores a crucial point. While patients primarily interact with doctors and nurses, the healthcare experience is far more intricate. As she astutely notes, “no one gets paid unless the coding gets done.” This statement highlights the vital, yet often invisible, role of medical coders.
What is medical coding?
To demystify this essential function, Laura Gross provided a clear definition.
“Medical coders act as translators. We convert detailed information found in patient medical documents – physician’s notes, lab reports, procedures, and diagnoses – into universal medical codes. This meticulous process ensures accurate medical records. Those records are then utilized by healthcare providers and insurance companies for billing and record-keeping.”
How does one become a medical coder?
The path to becoming a medical coder requires specific education and certification. Kastner explained the need to complete a degree or certification program encompassing medical terminology, anatomy, physiology, and pharmacology.
“Aspiring coders must also pass a proctored examination. Furthermore, the learning doesn’t stop there. Continuous education is mandatory to keep abreast of the ever-evolving guidelines in the healthcare landscape. Staying updated is paramount due to the constant changes in regulations.”
How complex a task is coding?
Garcia Patino notes there are multiple complexities in the coding systems themselves.
“The most universally recognized alphanumeric codes are the International Classification of Diseases (ICD). This catalog of codes is maintained by the World Health Organization (WHO) and classifies symptoms, diseases, illnesses, and causes of death.
Garcia Patino pointed out a significant shift from earlier ICD versions to the current ICD-10, which dramatically increased the number of codes. Beyond ICD codes, Gracia Patino explained the importance of Current Procedural Terminology (CPT) codes, developed by the American Medical Association, and the Healthcare Common Procedure Coding System (HCPCS) codes, developed by the Centers for Medicare and Medicaid Services (CMS).
“These codes identify medical, surgical, and diagnostic procedures and services within the U.S. They are categorized into procedures for contemporary medical practice, clinical labs, and emergent technologies. Much of what we do in coding remains behind the scenes for most people.”
Coding serves a important function
Janssen illuminated the critical role of medical coding.
“It’s not just about ensuring correct medical billing and insurance claim processing. There’s also value in research and basic medical record-keeping. Each code provides specific information about diagnoses, procedures, and services. This acts as a universal language to quantify healthcare visits and clarify physicians’ notes for insurance carriers and future healthcare providers. The specificity of these codes is vital for accurate data collection and appropriate reimbursement.”
Coding versus Billing
Lest anyone mistake the two, Kastner noted coding and billing fulfill entirely separate roles.
“Patients may confuse the two functions. Medical billing focuses on the financial transactions between insurance carriers and healthcare providers. This involves claims processing, bill generation, and payment management. Medical coding, conversely, extracts billing information from patient records and translates it into the standardized medical codes. While both deal with medical records, their focuses are distinct.”
Unsung heroes
HIM staff are dedicated professionals working tirelessly behind the scenes, ensuring the accuracy and efficiency of our healthcare system. The next time you receive a medical bill, remember the skilled coders who meticulously translated your healthcare journey into a language that ensures proper care and reimbursement. They are the unsung heroes of healthcare, and their work truly matters.
