ICD-10 and Training to Become a Medical Biller or Coder

Barry Lenson

ICD-10 RulesAs we’ve noted before on this blog, the demand for medical billers and coders is increasing steadily. There are many reasons why. Perhaps the most important reason is that the number of healthcare providers is growing fast in America. There are now urgent care centers, diagnostic centers, short-term surgical centers, and other care providers that simply didn’t exist only a few decades ago. The demand for medical billers and coders has also increased because we have an aging population, and older people need more medical care. There’s also the growing complexity of America’s health insurance industry, which has caused more physicians and other care providers to hire medical billers and coders to file insurance claims. And make no mistake about it – the demand for medical billers and coders will only increase under the new Affordable Care Act.

But here’s something ironic. Just as the demand for medical billers and coders is surging, they will soon be required to possess even more knowledge than they have in the past. Here’s the scoop . . .

For many years, The World Health Organization has maintained a diagnostic guide called the International Statistical Classification of Diseases and Related Health Problems (ICD).  It lists tens of thousands of medical codes for different medical conditions and treatments like tubercular meningitis, rat-bite fever, and plain old chicken pox. If you’re sick, the ICD has a name for what’s ailing you. And if a healthcare provider treats you for one of those conditions, a medical biller and coder is going to have to submit the right ICD code for that ailment to your insurance company.

If you trained to become a medical biller and coder in recent years, you had to learn about the ICD-9, which has been the most up-to-date version of the ICD. But soon you will have to be trained to understand and use a newer version that has the appealing name, ICD-10-CM/PCS. (Let’s just call it the ICD-10 to keep it simple.)

If you thought the ICD-9 was jumbo, wait until you see ICD-10! According to a description of ICD-10 on Wikipedia, “The code set allows more than 14,400 different codes and permits the tracking of many new diagnoses. The codes can be expanded to over 16,000 codes by using optional sub-classifications. The detail reported by ICD can be further increased, with a simplified multi-axial approach, by using codes meant to be reported in a separate data field.”

In brief, that means that the newest set of codes, the ICD-10, will require a lot more specificity regarding ailments. And guess what? Although the date for the implementation of ICD-10 seem to shift constantly, the current best guess seems to be that it will required as early as year 2014. Next year, in other words.

If you’re thinking of becoming a medical biller and coder, what does that mean for you? For one thing, it means that you are going to need to know more about diseases than medical billers and coders had to know in the past. But mostly, it means that you are going to have to know more about human physiology. Here's an example . . .

It won’t be enough to submit an insurance claim that states that a patient has a disorder of a cranial nerve. You are going to have to specify that the patient has a disorder of the olfactory nerve, the glossopharyngeal nerve, the vagus nerve, or the hypoglossal nerve. If a patient has a disorder of several of those nerves, there will be a different code for that too. As a medical biller and coder, it will help you a lot to know where all those nerves are. If you submit the wrong code for an ailment, your insurance claim will get bounced back. That won’t make your employer too happy, because he or she will not get paid by an insurance company until the claim you submit is processed. (Please note that some of this complication was already present in the ICD-9 codes as well; it’s not all new.)

So if you’re thinking of training to become a medical coder and biller, it makes the most sense to start out by taking a course in Anatomy & Physiology. Once you know the difference between your kidney and your big toe, you’ll be on your way to mastering the mysteries of ICD-10. And also on your way to getting a foothold in one of the fastest growing medical professions.

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