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Role of Service Codes in Medical Billing

Service codes in medical billing evolved in the medical field in the 17th century when the bubonic plague broke out in London. Since then, doctors have been using service codes to identify the symptoms and causes of illness in order to treat patients and reduce further deaths. Then doctors used service codes and they became an important tool for taking action against diseases. Now, in this era of advancement in technology, medical billers are using medical codes/service codes in medical coding to ensure the accuracy and consistency of service codes in medical billing procedures. So, medical billing services for small practices use different codes compiled by medical coders to correctly identify patient data and information to make the billing process easier and faster.

What Are Services Codes?

Moving ahead for further discussion, it is pertinent to clarify the concept here what are the services codes actually?

“Service Codes in Medical Billing Services refer to the codes that  interpret and medical practice process to make it easier. Medical Code identifies and describes an item or service which uses the Current Procedural Terminology (CPT), Healthcare Common Procedure Coding System (HCPCS), or Diagnosis-Related Group (DRG) codes”

Service codes identify the hospital service to which patients are admitted. PSVC1 is the service designated on admission. PSVC1-PSVC6 are used to record a transfer in service or subsurface during one hospitalization. The first two positions are mandatory.

If a patient transfers between services in the course of admission, the primary service code PRIMPSVC refers to the service on which the patient was treated for the greatest length of time, which is not necessarily the first service on admission.

Clinicians and healthcare workers are the main consumers of service codes. They use it for a range of medical things, such as treatment plans and claims reimbursement. The research hospitals use the information, health insurers, and various governmental organizations to monitor claim payments, assess insurance coverage, survey or research public health initiatives, and much more.

Service Codes in medical billing

Services odes make it simpler to convey the massive amount of data that crams into the American healthcare system. They are a common method of communication between medical professionals and hospitals across the country. This helps with analysis, research, and trend tracking to treat patients as effectively and productively as is humanly possible. Medical decisions will be better and more accurate the more succinct the data and statistics are, and better medical judgments result in better patient outcomes. And the medical coder is where it all begins.

The role of Service codes is to provide linkage and support for the individual to a range of culturally appropriate providers to meet physical and medical needs. So, place of service codes provides more details regarding the location of treatment and hospital admissions statistics. For example:

  • Number of physician office visits with infectious and parasitic diseases as the primary diagnosis: 15.5 million
  • Number of emergency department visits with infectious and parasitic diseases as the primary diagnosis: 3.7 million
  • A number of emergency department visits resulted in hospital admission with a principal hospital discharge diagnosis of infectious and parasitic diseases: 280,000, approximately.

Service Codes and Hospitals

With the use of this information, experts can observe and track more easily and diseases and analyze treatments statistically. For instance, hospitals and medical organizations frequently use this information to plan and make medical decisions that guarantee their organizations have adequate support systems in place during a crisis or natural disaster.

Determine medical necessity with the help of service codes in order to prove the medical necessity of the treatments or supplies they offer to a patient, the providers mostly rely on documentation and diagnosis coding. The patient’s insurance company will not pay the provider without meeting these conditions. Therefore, thorough documentation and uniform coding can prove the medical necessity of non-covered therapies and launch national coverage evaluations that could result in expanded coverage.

As we know, it is also possible to record separately the findings of diagnostic tests or studies that the doctor (i.e., the professional component) interprets and to prepare a distinct, signed written report using the appropriate CPT code and, if necessary, addition of modifier 26.

Final Thoughts

The ultimate goal of any healthcare provider is to ensure the health and well-being of patients. However, just as important is meeting the health care needs of the people who make up your practice, such as medical billing and coding. These areas are integral to any successful practice. Both of these functions fall under health information management, which, needless to say, requires accuracy to avoid costly and sometimes fatal errors.

Finally, accurate medical coding equals accurate medical billing. Medical coding is the process of converting medical diagnosis and procedure data into standardized medical codes. Current Procedural Terminology or CPT codes are uniform codes that relate to various procedural, surgical, medical, and diagnostic services offered by health care providers. The medical staff understands the codes and medical coders to maintain patient confidentiality.

More From Author: How Providers Are Responsible for Risk Adjustment Records

Jesse Handerson

I am a professional blogger at a renowned medical billing company. I used to write quality blogs and articles related to medical billing company and practice management etc.

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