What is Clinical Coding?

17/05/2017

Clinical coding is a health administration function that involves the translation of written clinical statements into a code format. A clinical coder will analyse information about an episode of patient care and assign standardised codes using a classification system. For example, acute appendicitis is represented by the code ‘K35.8′.

For coding diagnoses, most nations use the International Classification of Diseases 10th edition (ICD-10), developed by the World Health Organization. The standardised codes used in Australia are defined in the ICD-10 AM, which is a customised Australian modification. Other countries have also adopted the Australian coding framework, such as The Kingdom of Saudi Arabia, whereas its neighbouring country, The United Arab Emirates, has adopted the U.S framework known as ICD-10 CM. Nations wishing to code procedures/surgery have had to develop their own classification for procedures, or purchase a procedural classification from another nation.  Australia, Britain, the USA and Canada have all developed their own classification for procedures

What Does a Clinical Coder Do?

A clinical coder is responsible for deciding which diagnoses and procedures found in medical records meet the criteria for coding according to relevant standards. The coder then assigns codes and procedures for these diagnoses based on ICD-10 AM or CM conventions and standards. Clinical coding is a specialised skill that requires knowledge of medical terminology, anatomy, physiology, disease processes and analytical skills.

The data produced represents an integral part of health information management and is used for a variety of reasons, including:

  • Clinical research and audits
  • Health resource allocation
  • Medical Billing
  • Epidemiological studies
  • Clinical benchmarking
  • Case mix management
  • Health services planning
  • Education
  • Statistics

In many countries, including Australia, the assigned codes and other patient data are also processed by software to determine a Diagnosis Related Group for the episode of care. This can then be used for funding and reimbursement. This process allows hospital episodes to be grouped into meaningful categories, helping professionals to better match patient needs to health care resources.

Benefit of Outsourcing Clinical Coding Duties

For many years, there has been an extended shortage of full-time clinic coders in hospitals. Hospital administrators can solve this problem by hiring one experienced team to manage transcription, billing, appointment scheduling and coding, ensuring increased convenience and reduced costs.

Experienced clinical coders will have advanced knowledge and an impressive track record working within the relevant healthcare systems and across different coding frameworks. Coding services can be flexible and scalable, allowing you to utilise the services whenever necessary, for example, to cover for staff absences or to clear an arrears backlog.

Remote Clinical Coding with Synapse

Synapse offers multi-jurisdictional professional clinical coding services that are flexible, transparent and competitively priced to suit the needs of individual clients. Whether you need ongoing coding support or you want to catch up on a growing backlog of claims, our team can help.

Our clinical coders have extensive experience working across three continents and multiple coding frameworks. Whether your health care system works with the US or Australian coding frameworks, ICD-9 or ICD-10, our specialists can step in at any time to reduce overheads, rejections and arrears.

To find out more call us today on 1300 510 114 or contact us online.

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