Medical coding is an essential process in the healthcare industry that involves converting medical diagnoses and procedures into codes used for billing and reimbursement purposes. However, it is a complex and challenging field full of hardships and complications. These hard parts and challenges may lead to errors in coding and hence comprise the revenue of medical practices if not handled carefully and professionally. It is the duty of individuals who are involved in coding to overcome these obstacles.
To overcome these hardest parts and complications, professional and experienced medical coders are required; therefore, medical organizations prefer skilled coders who pass these hurdles to run their Revenue Cycle Management (RCM) flawlessly and smoothly because medical coding is the pillar of RCM which necessitates accuracy. Professional coders to deal professionally with the hardships and challenges are the need of the hour for any medical facility.
This post will delve into a detailed discussion about some most complicated aspects of medical coding faced by medical coders in their daily life and work.
There is a common concern among people “Is medical coding tough?” Medical coding might be tough but not impossible, i.e., there are some parts where coding seems most problematic, and coders have to face challenges on the way towards accurate denials and smooth RCM, but with skills, expertise, and consistency, these obstacles can be overcome easily. Let’s discuss a few hardest parts that appear in medical coding and can be perplexing for medical coders.
The principal codes used for medical coding are ICD and CPT codes. ICD-10-CM codes signify why the patient approaches the healthcare provider; meanwhile, ICD-10-PCS codes for the inpatient treatment and procedure the practitioner provides. In comparison, CPT codes demonstrate outpatient services and treatment.
But these coding sets do not remain the same, and updates often occur in the coding system ICD-9 was used formerly, but with time, it was transformed, and ICD-10 was developed with 140000 new codes.
So, it is a challenge and hardest part for a medical coder to stay updated with these regular evolutions or adapt to these changes quickly. A survey conducted by the Health Information Management Systems Society (HIMSS) in 2018 found that the biggest challenge facing medical coders was keeping up with the constantly changing coding systems. However, keeping up with these changes is necessary for accuracy and timely reimbursement
The accurate documentation must include but is not limited to the following:
Interpreting this information is not easy because of issues in the documentation provided by the healthcare provider. Faulty and inaccurate coding is not always due to the negligence of coders. Sometimes, healthcare practitioners forget to put complete information or insert erroneous information about the patient. So, documentation using this incorrect information leads to the following:
A survey conducted by the American Health Information Management Association (AHIMA) in 2017 found that the top challenges facing medical coders were staying current with coding changes, dealing with incomplete or ambiguous medical records, and managing coding backlogs.
To prevent all these complications, the medical coder has to analyze every minor detail of patients’ records which is challenging.
Medical cases can range from straightforward to highly complex, and coders must be able to deal with both. Complex cases can involve multiple diagnoses, procedures, comorbidities, and coexisting conditions. Moreover, upcoding and under-coding are also considered in the same category. In these cases, coders must be able to apply their knowledge of medical terminology, coding systems, and guidelines to assign codes, which can be challenging and time-consuming accurately.
Coding guidelines are set by governing bodies such as the Centers for Medicare and Medicaid Services (CMS) and the World Health Organization (WHO) and must be followed by medical coders. These guidelines outline the rules for coding diagnoses and procedures and can be complex and challenging to understand. As a result, coders must have a thorough understanding of the guidelines and be able to apply them accurately to ensure that the codes assigned are correct and the healthcare provider is reimbursed correctly.
Medical coding is a fast-paced field, with coders often dealing with high volumes of medical documentation. As a result, coders must balance their need for speed with accuracy. This can be challenging, as mistakes in coding can have serious consequences, including incorrect billing, denied insurance claims, and even malpractice lawsuits. This may lead to stressful conditions. Now, the question is;
Medical coding can be high-pressure and stressful because it is full of challenges and complex parts. Moreover, this profession is also time-sensitive as it affects the billing and reimbursement process, contributing to a stressful situation. Ultimately, the stress level experienced by coders in medical coding can vary depending on individual factors such as their experience level, workload, and personal coping strategies. It is necessary to overcome the stress and not let anything get on your nerves because it might lead to errors in coding. To reduce the stress and maintain a balance between speed and accuracy, medical coders must/has to:
The healthcare industry is heavily regulated, and there are numerous rules and regulations that medical billing professionals must comply with. One of the biggest challenges of medical billing is the complex regulations that healthcare providers must navigate. As medical coders work with patient’s data and information daily while handling patients’ personally identifiable information or records and dealing with patients’ payment information, coders must adhere to updated privacy laws, including the Payment Card Industry Data Security Standard (PCI-DSS) and Health Insurance Portability and Accountability Act (HIPAA). You can maintain compliance by adhering to these modifications.
One of the biggest challenges of medical billing is dealing with denied claims by insurance. According to data from the Centers for Medicare and Medicaid Services, 48.3 million claims, i.e., 16.6% of the total, were rejected in 2021.
Various reasons lead to denied claims in the healthcare management system, such as:
Dealing with denied claims can be time-consuming and frustrating. Coders have to re-check all the factors, find possible reasons for the denials, and take necessary steps to correct the issues. This process can be time-consuming and requires attention to detail, as even a tiny mistake can result in another denied claim.
Medical billing and coding are professions in the healthcare industry that require education and expertise. Medical coding can be challenging, as it requires a strong understanding of medical terminology, anatomy, and medical billing and reimbursement processes. Medical coders must also be knowledgeable about classification systems such as the International Classification of Diseases (ICD) and the Current Procedural Terminology (CPT) codes, which are used to assign codes to diagnoses and procedures. But, it is not impossible because you can learn everything with proper training and skills. That being said,medical coding is a highly rewarding career for individuals who are detail-oriented, organized, and has strong analytical and critical thinking skills.
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