Medical coding: An asset or a headache for the healthcare industry?

20170421150000, Raphael Cheong
Just as systems such as the Electronic Medical Records have shown, medical technologies take time to stabilise.
At first glance, the alphanumeric code ‘A01.0’ may not come off as much, but it is in fact the medical code assigned to ‘typhoid fever caused by salmonella infection’ in the International Statistical Classification of Diseases and Related Health Problems 10th Revision (ICD-10), rolled out in the United States in 2015.

Medical coding has long been touted as a ‘saviour’ of sorts for the medical and healthcare industry because of how efficient and convenient it makes the process of billing. Practitioners simply have to input the kinds of services that were rendered to patients and the codes will enable a claim to be generated, to be paid by insurance carriers.

The drawbacks of using medical coding


Perhaps the most pertinent problem with regards to medical coding is the difficulty to draw the line between specificity and complexity. In fact, the implementation of codes may make the job of coders and billers easier, but not without first making it more complicated.

For one, the barrage of lexicon constantly being added to the coding language renders its understanding and memorisation extremely difficult. The ICD-10 has over 70,000 codes, up from 14,000 in its predecessor, the ICD-9. Also, the numbers are only expected to increase in future updates, as coders are working on coding even more services.

Moreover, the process of using codes is also extremely tedious. For instance, for a condition such as “acute systolic heart failure’, specific supporting data needs to be presented. Submitting a bill without meeting all criteria runs the risk of committing fraud.

Due to the fact that medical coding is still a relatively new process, not many laws have been put in place to enforce it. Situations such as the one above certainly show that legislation will be a tedious process that has many grey areas.

Digging deeper, the situation only gets murkier. Some doctors have revealed that they pay to take courses to learn how they can “upcode” – use coding knowledge to their advantage – patients; that is, charging more than is necessary by performing a seemingly insignificant process. Extra processes such as weighing the patient or listening to their lungs with a stethoscope can in fact increase the cost of the bill significantly.

Why medical coding is advantageous to healthcare


However, where an excessive amount of paper had to be used for bills in the past, they can now be condensed. Additionally, in some cases, it can now be done completely electronically through a billing system without the use of paper at all. This is good news for coders and billers as they can perform tasks more efficiently and effectively, bringing about greater productivity.

With all these in mind, whether medical coding will be beneficial or detrimental for the industry in the long run still awaits to be seen. Hopefully, in the near future to come, hospitals and insurers alike will delegate coders for specific branches of codes, a structure that is not that different from healthcare itself.

Just as systems such as the Electronic Health Records have shown, medical technologies take time to truly settle down and stabilise. Medical coding will be no different, and only time will tell if swapping printing for coding truly is a blessing rather than a curse. MIMS

Read more:
The quest of precision medicine, at what cost?
Design thinking: an out-of-the-box approach to healthcare solutions
500,000 medically sensitive NHS documents went missing for five years

Sources:
https://www.nytimes.com/2017/03/29/magazine/those-indecipherable-medical-bills-theyre-one-reason-health-care-costs-so-much.html
https://www.scientificamerican.com/article/why-you-should-care-about-the-new-major-changes-in-medical-billing/
https://www.findacode.com/articles/evolution-of-medical-coding.html