Coding System Now More Complex For Medical Billing, Procedures

Since October, physicians and hospitals across the United States have been grappling with a massive new coding system required for procedures and lab tests.

Thousands of new codes and more detail are needed to explain the patient visit and insurance claim as part of he 10th edition of the International Classification of Diseases.

Bonnie Gerhart, the inpatient coding/CDI manager for Augusta Health, said coding specialists have had more than a year to prepare for the change.

“Coders have gone through a lot of education the past two years,” said Gerhart, who said the coders have learned what to expect.

And while the transition has been relatively smooth for Augusta Health, Gerhart said there have been challenges. The change has provided an extensive learning curve for physicians, and the learning is still happening.

“They didn’t have the education to get ready. They are relying on us,” Gerhart said. She said the result has been that coders go back to physicians to make sure they have all the information about a lab test or procedure.

“It takes extra time, but I think our system is working pretty well,” Gerhart said. “We are educating our doctors on being more specific and to give us the information up front.”

She said the transition for doctors is being aided by an Augusta Health physician advisor. “He’s really great. We can use him to bounce questions off him,” Gerhart said.

Gerhart said the order starts when the medical records are sent to the coding office. “We review the medical information for what we code and put it in our coding system. That dumps it into the billing office,” she said.

Part of the rationale for the increased coding is to allow researchers and doctors to obtain a closer look at trends in one medical office or across the country.

The acting administrator of the Centers for Medicare and Medicaid Services recently told The Associated Press that will offer some flexibility during the first year of assessing claims, provided the coding is close.

Gerhart said another factor in the new coding is the number of new medical procedures being created every year.

“Medicine is just amazing,” she said. “There are new procedures all the time.”

Via dailyprogress.com