What you don’t know may surprise you.
By Patricia Elliott, M.Ed, RHIT
Health Information Management and Coding Program Coordinator
Coding Specialist Certificate Program
MCCKC-Penn Valley, Health Science Institute
Have you ever wondered what the coded numbers and letters are on your doctor’s bill, hospital statement or insurance bill? These codes are required in order to reimburse medical providers for services rendered. What you may not know is these codes are also used for research data for disease outbreaks, reporting the number of cases of cancer diagnoses, as well as for oversight of population health, wellness and prevention. When codes are reported to the
Centers for Disease Control (CDC), that information is used to monitor and report on epidemics. When you hear about the reported number of flu cases and deaths, or reporting on recall of romaine lettuce due to salmonella, it is a result of data submitted on medical report ICD-10 codes to the CDC.
WHAT ARE ICD-10 CODES?
The International Classification of Diseases, 10th Revision, Clinical Modification (ICD-10-CM) codes report health diagnoses. In addition to these codes there are other codes that report surgical procedures, outpatient procedures and the use of durable medical equipment. All of these codes are required to reimburse providers.
HOW DOES THIS HELP ME AS A PATIENT?
If you have ever received medical treatment or have been discharged from a hospital, for the purpose of billing, your health records are sent to the medical coding department to someone who has been trained and credentialed in the specialty of coding. They assign the appropriate code to each diagnosis based on your physician’s documentation. Keep in mind this documentation must meet medical necessity and the billable procedures or services must match the diagnosis. It’s very important that your doctor and other staff responsible for tracking your care and treatment be specific in their documentation in order for the diagnoses and procedures to be coded properly. Coding errors can occur if reported data are wrong. Inaccurate data can result in delayed reimbursement to medical providers who treated you, as well as impact funding for health research as explained earlier.
WHAT SHOULD I LOOK FOR?
Take time to read every doctor’s and/or insurance company’s Explanation of Benefits (EOB) form that you receive either electronically or in the mail. It is important to review the EOB because it explains what you were charged, what was paid and what you as the patient will be responsible for paying. This EOB is also verification that services you were charged for were actually provided. With medical identity theft on the rise, it’s important to protect yourself. Report any suspicious billing records to your doctor and insurance company. And remember, you might not know if the billable code(s) are correct, but you will know whether or not you received treatment on the dates of service billed. Contact your providers and insurance companies right away if you find inaccurate documentation or mistakes.
For more information about the Coding Specialist Program call 816.601.1000 or visit mcckc.edu/programs/healthinfomanagementcoding/.