Importance of Diagnosis and Medical Coding in Healthcare

Running head: MEDICAL BILLING AND CODING
MEDICAL BILLING AND CODING
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What does a diagnosis or diagnostic statement tells us?
Diagnosis is the detection of any medical condition that needs treatment. It is a process of
determining the disease that is explained by the person’s symptoms and condition. Diagnosis of a
disease is important to begin treatment. The information or medical data that are required for
diagnosis are generally collected from patient’s medical history and through physical
examinations. When a diagnosis is exact and created in time, a person has the greatest chance for
promoting wellness since the decision-making process is designed to ensure improved outcome
of the patient (Hoeppner and Marilu). There are a variety of diagnostic procedures like medical
tests such as blood test, ECG, X-ray, ultrasonography and others. Depending on the type of
illness the patient is seeking medical help, different approaches of diagnosis are applied. Patients
are treated based on the diagnosis data and doctors plan treatment strategies from these data.
Diagnostic process requires medical information of the patient including history,
condition and symptoms the patient is having. To start the treatment based on the diagnostic
results it is very important to know the whole story including medical history. Medical
conditions and past history gives us information about what and how to treat the patient against
the particular disease.
Why is it important to tell the “whole story” of the encounter?
Medical codes are required in order to convert patient’s documentation into standardized
codes that gives information of the patient’s diagnosis, medical requirements for the treatment
and services and facilities. Health codes must tell the entire history of a patient's meeting with
the doctor and must be as specific as possible to collect reimbursement for services rendered
(Whitmer and Elizabeth). The primary task of a medical coder is to review and assign standard

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codes on the clinical statements of the patient using different classification systems. Medical
accountants handle and track allegations for the reimbursement of facilities provided by a
medical supplier that are forwarded to insurance undertakings. It is important to know the whole
story of the encounter as it helps to understand patient’s documentation and the diagnosis
assigned to the patient and also helps to determine the procedures performed when they visited
the physician (Ansah and Evelyn).
Pre-existing condition and its importance to the professional coder
In the US, a pre-existing health condition is a medical condition which has begun before
the health benefits of an individual have come into effect. When an individual requests for health
insurance, he or she will complete a medical history questionnaire on their medical history. An
authorized healthcare supplier may also have to undergo a physical exam to determine their
health status (Whitmer and Elizabeth). The insurance companies may choose with this data to
exclude coverage on certain terms while still offering complete protection of the pre-existing
conditions for regular or acute care.
Conditions affecting commercial health insurance are circumstances which continue
when an insurance plan is implemented. There are no previous circumstances for which patients
have not been treated any more. The patient's diagnosis is reported by professional medical
healthcare providers and certified medical coders in accordance with universal medical code.
The right code will allow patients to get advantage fully from their health benefits. Medical
codes are allocated on the basis of the available information documented in the medical history
of the patient. Without definite diagnosis, medicine coders and billers do not attribute final
diagnostic codes (Deverka et al.,). If the person is not yet affected by any disease, the reasons for
the arranged tests are the signs justifying the tests to be performed. The licensed medical coders