Understand Hospital Coding & Billing
Coding is the process of assigning numerical codes to a patient's diagnoses and procedures for the purpose of billing. Billing is done in order for the hospital and health care providers, like physicians, to obtain reimbursement for the services provided to patients. Once the codes are billed to the payer, the insurance company reviews the claim and makes reimbursements based on the code assignments. In cases where the insurance company denies a claim, additional documentation or correct code assignments may be warranted.
Hospital, or acute care, coding is reported mainly through a classification system known as ICD-9-CM code assignment. For outpatient procedures and some payers (like Medicare and Medicaid), an additional coding classification called CPT is used.
Instructions
1. Identify diagnoses and procedures by reviewing the patient information. Diagnoses are the current conditions, diseases or injuries of the patient. Procedures are treatments or surgeries performed on the patient during the hospital stay. List the pertinent patient diagnoses and procedures.
2. Assign the appropriate ICD-9-CM (soon to be ICD-10 in 2010) codes to all of the patient's pertinent diagnoses and procedures. In an inpatient hospital setting, ICD-9-CM is the classification system used to assign codes for both diagnoses and procedures.
3. Assign Current Procedural Terminology (CPT) codes to hospital outpatient procedures and patients with Medicare or Medicaid insurance. CPT codes are five-digit procedure codes used to identify surgeries and procedures performed on patients in a hospital outpatient setting. Although they aren't required to be assigned on inpatient procedures, many of the coding software systems now automatically assign CPT codes when any patient procedures are done.
4. Prioritize the codes. List the reason the patient came into the hospital first in the diagnosis section of the coding form, with the corresponding surgery (if any) first in the procedure section of the coding form. The listing and prioritizing of the diagnoses and procedures drive the hospital payment calculation. This means that the hospital could lose significant reimbursement if you prioritize the codes incorrectly.
5. Finalize the codes. Review the code assignments one more time to ensure that you've coded all diagnoses and procedures. Mark the code statement as finalized for the billing department.
6. Bill the payer. Most hospital billing systems and payers are equipped to transmit and receive the claim electronically over the Internet. In most hospitals, the coding and billing department is separate. The coder assigns the codes and the biller works with claims and payment processing.
Tags: diagnoses procedures, code assignments, assign codes, billing department, classification system, codes patient