Medical Coding: Why Is An 'Easier' System So Complicated?

Believe it or not, there was a time in this country when paying for medical care was fairly simple. Your doctor rendered services for which you paid at the time of the visit. Medical insurance only offered catastrophic coverage for major medical events. Those were simpler days.

These days, medical payments are so much more complicated. Yet it is not supposed to be that way. Medical coding and billing standards were originally introduced to make payments and reimbursements easier. It didn't work out that way. What was supposed to be an easier system is much more complicated than it ever was before the system was developed.

Tens of Thousands of Codes

As any medical coding specialist knows, looking up and assigning codes is a gargantuan task. There are literally tens of thousands of codes a specialist might deal with in a given year. Granted, some of the codes are used more frequently than others.

The most frequently used are easily memorized by coding specialists. But nothing in healthcare is routine. Even what appears to be a simple record of services performed can be turned upside down by one arcane code a specialist isn't familiar with.

Assuming you are a medical coding specialist, you know what you're up against. You need to be familiar with:

●    ICD-10 and ICD-11 codes
●    Common Procedural Terminology (CPT) codes
●    National Provider Identifier (NPI) numbers
●    HIPAA Compliance

These four things barely scratch the surface. There are other code sets and identification numbers to be familiar with. It's a good thing that medical coders can trust sites like ours to look up codes online. Having to thumb through printed manuals in the modern era would be a nightmare.

No Easier for Some Patients

Our overly complex coding and billing system is tough enough on healthcare providers and their coding and billing specialists. It is tough on payers, too. But the one forgotten group in this whole mess are the patients. Things are no easier for them.

Imagine a patient looking over a group of medical bills trying to understand what he is being billed for. He doesn't understand the codes. And even if he can find a website that allows him to look up diagnostic codes for free, he is not likely to understand the medical terminology associated with those codes. How is the patient to know if he is being billed correctly?

Another example is found with transgender patients who have trouble getting reimbursed from their insurance companies for covered procedures. Regardless of how any of us feels about transgenderism, an insurance company that promises to cover medical procedures should do so. Patients should not have to jump through hoops to get reimbursed.

On this particular issue, some say that a big problem lies with ICD-10 codes. First introduced in 2015, the codes are inadequate for defining some of the treatments transgender patients receive. Coders do not know how to code services, ultimately leading to disputes between billers and payers. Transgender advocates say that the U.S. system should be switched over to ICD-11. Making the switch would alleviate some of the difficulty.

Too Many Hands in the Pie

Stepping back and looking at it from a neutral perspective reveals that there are too many hands in the pie. There are too many organizations and entities involved in establishing medical coding standards. As such, the standards we do have are not really standards at all.

Establishing medical codes was supposed to make medical billing easier. Instead, it has made things much more difficult than they ever were. Adding new codes to old doesn't make the system any better.

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