Medical Coding Training: Learn How Medical Necessity and ICD-9 Coding Intersect


It really important that we should code diagnoses compliantly. Most providers often say, “What's the big deal?”. Well, first and foremost, our diagnosis codes or ICD-9 are required use by HIPAA. Read this expert medical coding and billing article for more information.

And they are included in the transaction code set. Payers no longer can create their own diagnosis codes. It's required to follow only the diagnosis codes that are currently in ICD-9.

We all know that ICD-9 medical coding in the United States is used to create medical necessity that link over to get our claims reimbursed so that if we're doing say a lumbar epidural injection, we can't link it to a diagnosis code of pneumonia. Most payers wouldn't create, allow that to be processed for payment. But more importantly, lots of providers and practices don’t understand that ICD-9 codes are also used for statistical analysis for database formation. They get that data from the claims that we submit.

One of the reasons is epidemiology. What that means is truly the primary reason that ICD-9 medical coding was created back in the late 1800s was to track morbidity and mortality worldwide. And so, back then, they were looking at say bubonic plague, those types influenza. Where today, there's also very to have those types of diseases but things like Ebola, swine flu but also looking at the numbers of reports of low back pain spondylosis.

Payers use ICD-9 codes that get reported to look at the resources they're utilizing. How much money did they spend on a particular disease category? They look to see did all their beneficiaries that have diabetes have the required eye exams as a preventative type source. They use diagnosis codes for outcomes, using it for evidence based medicine. That's how we locate patients to look and follow their outcomes.

And last but not least, we must keep in mind that diagnosis codes are an excellent source to be able to locate the applicable patients for clinical trials. It would be very honored. If we had to go through electronic medical records or our paper charge to train fine patients that could potentially be in clinical trials. So it's very important that we report our diagnosis codes accurately each and every time to ensure accurate and error-free medical coding and billing.

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