Diagnostic Coding is a method healthcare providers use to determine how a diagnostic test or procedure is identified in an electronic health record (EHR). A critical component of health information exchange (HIE) involves building clinical decision support tools that guide clinicians in making decisions for their patient’s care. Diagnostic Coding is the foundation of HIE because it enables referral, care coordination, and improved quality of care.
What is Diagnostic Coding?
Diagnostic Coding is a way of categorizing information and setting patients’ test results in terms that can be easily understood by physicians and nurses, who are responsible for recordkeeping and health care delivery. To the physician, diagnostic Coding is like alphabet soup. Diagnostics Coding has helped Cardiologists in several ways :
Helping Them Avoid Malpractice Charges
Malpractice insurance premiums are rising as more patients sue their doctors for making incorrect diagnoses. Malpractice insurance can be costly, and extra-legal expenses could be enough to discourage doctors from practicing medicine at all.
Helping Them Provide the Most Efficient Care to Patients While Also Reducing Expensive Readmissions
As more and more physicians are using EMRs, they have discovered that the information is there for them to use, but it is located in a system that is not designed to make it easy and quick for physicians to report test results. There are different diagnostic coding systems, each including strategies for organizing testing data. Each of these systems identifies a different set of test results. Each type of Coding has its pros and cons, and some are better suited than others for certain types of testing across different clinical settings. Diagnostic Coding is a huge benefit to doctors and hospitals because it enables referral, care coordination, and improved quality of care.
It Increases Patient Safety
CGI has identified that the high number of misdiagnoses in the medical field are due to inaccurate information entered into the EMR system. The misdiagnosis rate for cardiology is reportedly around 40%. Diagnostic Coding helps doctors ensure that there is correct information, which will allow them to identify potential significant or treatable conditions with fewer adverse effects if they are not treated medically.
Saving Time and Money
Inadequate documentation may lead to wrong diagnoses and undertreatment of patients. The medical field spends millions of dollars on unnecessary procedures and tests because results are not documented correctly. As stated by the CGI report, “Diagnostic Coding can help reduce costs by providing an accurate representation of lab testing information and by reducing extra test repeat studies.” Misdiagnosis can be costly for both insurers and patients alike. Accessing information quickly is an important part of properly diagnosing patients. Reporting accurate information to the EMR system improves doctors’ efficiency in treating their patients as well as helping to avoid expensive readmissions.
Improper use of EMRs leads to misdiagnosis and delayed care or treatment. According to a report by the Clinical Informatics Workgroup, as many as 50% of misdiagnoses are caused by incomplete information provided in the EMR system. Improved documentation will save time, money, and lives by improving care for patients who may have been in danger without the proper diagnosis. Cardiology medical billing service providers provide secure and efficient billing services that help practice operate effectively.
Capturing Higher Quality of Care, Especially in Cardiology
Medical Coding is now a standard part of patient care in cardiology. In the U.S., the National Council for Home Health Policy and the National Council for Patient Information and Education have recognized diagnostic Coding as an approved medical billing service option for healthcare facilities that already have an EMR system installed.
Best practices are important for improving efficiency in cardiology medical billing providers’ processes.
More accurate reporting can help avoid expensive testing procedures, redundant tests, and incorrect diagnoses.
Improving Quality of Care
Diagnostic Coding can bring benefits such as decreased mortality, increased treatment, and improved quality of care.
Reducing Mortality Rates
As stated by the Clinical Informatics Workgroup, misdiagnosis of heart attacks can lead to death. Additionally, delays in treatment after a misdiagnosis can cause additional problems for patients. Diagnostic Coding allows for information to be recorded correctly and promptly to avoid many of the problems associated with misdiagnosis.
Diagnostic Coding helps cardiologists manage their practices, patients, and health expenditures better. As medicine becomes more computerized, diagnostic Coding can improve the quality of patient care.