Our Journey
My journey began in the field of audiology in 1993. In 2004, I pursued my CPC certification. Despite facing trials and tribulation in 2020, I embraced the challenge to become an instructor. My goal is to empower future medical coders to achieve their utmost potential and overcome any obstacles in their path. What doesn’t kill you makes you stronger!!
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Are you ready for your transformation?
What is Medical Coding?
Medical coding is analyzing clinical documentation from different providers from different specialties and assign standardized procedure codes and link them to diagnosis codes. Coding the patient's visit properly and in compliance with the individual payer requirements makes this element key to the successful generation of appropriate revenue.
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Medical coding requires knowledge of medical terminology, anatomy, pathophysiology, pharmacology, understanding the different classification systems, their purpose and application of CPT®, ICD-10-CM, HCPCS Level II and ICD-10-PCS. Understand and apply the official ICD-10-CM coding conventions, general coding guidelines, Chapter-specific coding guidelines, diagnostic coding and reporting guidelines for outpatient services and inpatient services.
Servies = procedures and linked to diagnostic code(s) = why did they receive these services (ICD-10-CM).
Inpatient, the principal diagnosis is defined in the Uniform Hospital Discharge Data Set (UHDDS) as “the condition established after study to be chiefly responsible for occasioning the admission of the patient to the hospital for care.”
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Professional services (Pro-fee), the primary diagnosis (first listed diagnosis) is the reason for the visit documented in a medical record.
What is Medical Billing CMS-1500 (837P)?
Medical billing entails the submission and tracking of claims with health insurance companies to secure payment for services provided by a healthcare professional. This process includes converting a healthcare service into a billing claim and forwarding that claim to the insurer for reimbursement. The 837P (Professional) is the standard format used by health care professionals and suppliers to transmit health care claims electronically. The Form CMS-1500 is the standard paper claim form. Billing the 837P and Form CMS-1500 (08/05) may be suitable for billing various government payers and some private insurers.
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ANSI ASC X12N 837P The American National Standards Institute (ANSI) Accredited Standards Committee (ASC) X12N 837P (Professional) Version 5010A1 is the current electronic claim version for transmitting health care claims electronically P = Professional version of the 837 electronic format Version 5010A1 = Current version of the Health Insurance Portability and Accountability Act (HIPAA) electronic transaction standards for health care professionals and suppliers.
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The National Uniform Claim Committee (NUCC) has developed a crosswalk between the ASC X12N 837P and the hard copy claim form located on the Internet.
1500_claim_form_instruction_manual_2023_07-v11.pdf (nucc.org)
What is Medical Billing UB04, CMS-1450 (8371)?
The 837I (Institutional) is the standard format institutional providers use to send health care claims electronically. The American National Standards Institute (ANSI) Accredited Standards Committee (ASC) X12N 837I claim format.
The Form CMS-1450, also known as the UB-04, it’s the standard claim form to bill the facility side.
Institutional providers include:
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Community Mental Health Centers (CMHCs)
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Comprehensive Outpatient Rehabilitation Facilities (CORFs)
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Critical Access Hospitals (CAHs)
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ESRD providers
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Federally Qualified Health Centers (FQHCs)
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Histocompatibility laboratories
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Home Health Agencies (HHAs)
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Hospice organizations
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Hospitals
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Indian Health Service (IHS) Facilities
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Outpatient Physical Therapy (OPT)/ Occupational Therapy (OT)/Speech-Language Pathology (SLP) Services
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Skilled nursing facilities (SNFs)
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The ANSI ASC X12N 837I (Institutional) Version 5010A2 is the current electronic claim version.
The 837I and CMS-1450 also require codes maintained by the NUBC including:
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Condition codes • Discharge status • Occurrence codes
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Occurrence Span Codes • Point of Origin • Revenue codes
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Type of Bill • Type of Visit • Value codes
Learn medical coding from an AAPC approved instructor with over 20 years of experience in the field. Our comprehensive courses will equip you with the knowledge and skills needed to excel in the medical coding profession. Whether you are just starting or looking to advance your career, we are here to support your journey. Join us and unlock your potential in the dynamic world of medical coding.
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