Reflection on the Importance of Coding and Billing

Reflection on the Importance of Coding and Billing
The importance of correct coding and billing
Anatomy & Physiology I and Anatomy & Physiology II
Learning anatomy and physiology has been an impactful journey. Not only have I learnt new ideas, but also relate the knowledge to my daily experiences. In Anatomy & Physiology I, I studies the structures and functions of human biological components. This includes the cells, tissues, and organs of various body systems. The systems include the nervous, musculoskeletal, and integumentary systems. The system that intrigues me the most was the nervous system. The complexities of cognitive abilities and processes made me want to study more about it. In Anatomy & Physiology II, I learnt more on the various organ systems, their structures, and how they relate to one another. I learnt the normal functions of these organ systems. This knowledge was useful in identifying abnormalities in an organ system, thus establishing a disease process. Any deviation from the normal existence of the body is an indication of an abnormality, and should be addressed accordingly.

ICD-10 Codes

The ICD-10 is a World Health Organization (WHO)- generated list of medical classification. It has codes for “illnesses, clinical manifestations, abnormal findings, complaints, social circumstance, and external causes of injury or diseases” (Medical Billing and Coding, 2020). The standard version of the ICD is published by the WHO. However, the member states are allowed to make adjustments so it can suit their needs. There are more than 14,000 different codes for diseases, and there’s an additional feature for tracking new diagnoses. The ICD-10 is an efficient tool as it permits specificity regarding the cause, manifestation, location, severity, and type of injury or disease” (Medical Billing and Coding, 2020).

ICD-10 is an alphanumeric code with seven characters. Every code starts with a letter, which is followed by two numbers. The first three letters represent the category, which describes the nature of the injury or the disease. After the category, there is a decimal point, and the subcategory. The subcategory is followed by subclassifications, which describe the “cause, manifestation, location, severity, and type of injury or disease.” The last character in this code is the extension. It describes the type of encounter, i.e. if it is the first or subsequent encounter. Patient visits associated with the effects of a previous injury or disease are recorded with the term “sequela”. (Medical Billing and Coding, 2020)

There are also other conventions, apart from format, that help the coder to find the correct diagnosis codes. Among these conventions are the “excludes” and “includes”. The excludes are further divided into “excludes 1” and “excludes 2”. “Excludes 1” contains a list of codes that shouldn’t be coded with the above format (Medical Billing and Coding, 2020). “Excludes 2” contains a list of codes for diseases or injuries that may be part of the diagnosed condition, but are not included in the code (Medical Billing and Coding, 2020).

The impact of coding and billing on healthcare facilities and patients

Coding and billing in healthcare facilities is an essential constituent of any medical practice. It is imperative that accuracy in both areas is achieved since it has significant impacts on patient safety, rapid reimbursements, and improved efficiency in operations. These processes require highly skilled professionals to handle the accurately and efficiently, paying attention to details. Medical coding affects healthcare facilities directly by affecting their insurance reimbursements (Casto & Forrestal, 2013). It is a significant step in the submission of medical claims and bills to insurers. More emphasis is placed on 100% accuracy in coding patient procedures since inaccuracy can lead to withholding of insurance, and delays in billing (Casto & Forrestal, 2013). This leads to more work and frustrations for the parties involved- the patients and healthcare providers

References

Casto, A. B., & Forrestal, E. (2013). Principles of healthcare reimbursement. American Health Information Management Association.

Medical Billing and Coding. (2020). Everything you Need To get started in Medical Billing and Coding. Retrieved from https://www.medicalbillingandcoding.org/icd-10-cm/

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