I believe that medical coding is how they bill you, I’m probably wrong lol, but I still don’t really understand the full scope of it. I had a physical last year and the receptionist (kind of a bitch), told me that since it was a physical, I couldn’t bring any concerns up, I would have to schedule another appointment. And then I’ve heard people mention that their insurance didn’t cover something because the way it was coded.
In: Biology
When you go see a doctor, they look at your symptoms, they may order blood tests or whatever, and then they’ll diagnose you (tell you what’s wrong) and prescribe medication.
To get paid, they have to “code” all of this so that someone who doesn’t have medical experience (like, the insurance company employees) can figure out exactly what the doctor did, that the insurance has to pay for.
So there’s a standard, the [ICD-11](https://icd.who.int/en) – International Codification of Diseases, that assigns a code to every possible condition out there. So a medical assistant goes into the [software](https://icd.who.int/ct/icd11_mms/en/release) and types in what the doctor said, for example “kidney failure”, and it shows a bunch of codes, GB60.z for example.
So the dr. office or hospital composes a bill, that instead of having descriptions it has just these codes. Patient was treated for: GB60.z, GB72.F etc etc.
And the insurance computer systems pull these codes from the database and can figure out pricing and other details.
It also isn’t just the coding for the illness or disease. Those who mentioned the ICD-11 before are right. Every illness, disease, injury, or reason to see a medical provider has a diagnosis code.
In addition to the diagnosis code, every treatment has a procedure code. So, the pig bite, initial mentioned earlier has a code for the diagnosis. The band aid, stitches, and antibiotics also get procedure codes. All of those codes need to match in order for payment to be issued.
For example, if you saw a doctor because you had the flu, the billing would have a code for the reason for the visit (the flu), a code for the length of the appointment (a 15 minute appt has a different code than a 30 minute appt), and if you were written an Rx, there might be another code for the writing of the Rx. Finally, all of these are done on particular forms, which might be different depending upon the type of insurance used.
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