Medical billers together with medical coders must have a good understanding of the ICD-9-CM (International Classification of Diseases-9th Edition-Clinical Modification. ICD-9-CM has three volumes with the first two having diagnosis codes, whereas volume number three has a list of procedure codes that are available. Medical coders for inpatient as well as medical billers utilize the third volume in describing medically needed services which requires a hospital setting. Every medical coder and biller relies on the first two volumes in support of the medical requirements of healthcare claims billing.
All procedures given to patients has a code assignment linked to a reimbursement charge corresponding to that code. Such codes are linked as well to the codes contained in the ICD-9-CM to justify why a particular procedure was carried out. For proper reimbursement, correct diagnostic coding becomes essential. If the diagnosis code attached to the service code is incorrect, payment of the ICD9CM billing will be rejected since it cannot be considered as medically necessary.
Bronchial endoscopy, for instance, cannot be considered medically required for patients with blood (599.70) in their urine, although it’s clinically indicated if a patient has chronic obstructive pulmonary disorder (496). Because healthcare claims are entirely submitted in codes that are universally recognized, a correct understanding of the meaning of the codes is essential in the submission of clean claims that are going to be paid upon first submission to either a private health insurance plan or a government health insurance program.
Healthcare providers will be able to assign codes during their service, along with medical billers as well as coders, according to the documentation in the medical record of a patient, which is under the scope of the professional duties they have. Each healthcare setting imposes its own responsibilities on coders and medical billers. In a medical practice that is large, compliance with diagnosis codes are assigned to licensed medical coders whereas in a smaller practice with one or a couple of physicians, if not in physical therapy clinics, for example, healthcare providers can assign ICD-9-CM codes keyed in by professional medical billers from their workplaces.
Healthcare providers are normally not formally trained in any medical billing or medical coding work. As such, they have to depend on experienced professionals specializing in such administrative discipline to guide them in observing the standards that ICD-9-CM sets forth. Trained medical billers along with licensed medical coders are people who have typically completed formal training programs in this study that gives them understanding of the protocols and methodologies of ICD-9-CM and also professional associations in reporting to healthcare providers the findings document in the medical records of patients.
These professionals work closely with the healthcare providers in submitting insurance claims to government healthcare programs as well as to private medical insurance firms. By accurately applying the codes established by ICD-9-CM, medical billers and coders maintain their employers’ compliance to existing policies and regulations of a constantly changing regulatory environment that aims to discourage fraud or abuse in healthcare.