Medical Coding Decoded: The Who, What & Why

Medical coding is a language spoken by few, but important to all. It’s the translation of healthcare diagnoses, procedures, medical services, and equipment into a universal medical alphanumeric code. These standardized codes – all 71,924 of them - document medical records and provide accurate billing information.

Its Impact:

• For Patients: Accurately captures their health status, including illness and expected health outcomes.
• For Providers: Supports proper reimbursement from payors, ensuring the correct amount of healthcare dollars are allocated to cover patient care.
• For Payors (Insurance Companies): Guides the implementation of their health management and quality-driven programs to further benefit their beneficiaries.

Coding, therefore, plays a critical role in risk adjustment. For example, reimbursement to care for a sicker patient can be properly directed when a patient’s status is precisely coded.

Medical coders play an essential role in Tandigm’s mission, such as:

• Reviews of clinical documentation to ensure accuracy and specificity.
• Education and feedback for providers to improve coding methods.
• Collaboration and resources to support implementation of quality patient care.

This team's tireless efforts – from ensuring data accuracy to educating our providers – help us achieve the quadruple aim of better health outcomes, lower costs, improved clinical experience, and improved patient experience.

Thank you to Jessica Diaz CPC, CDEO, CPB, CRC, AHCCA, Manager of Accurate Coding at Tandigm, for her input in developing this article.