As a part of the medical billing process, medical coders in the health information management
(HIM) department assign codes to patients' conditions and procedures. These codes are
reported on claims to represent the services the facility provided for the patient and the medical
necessity of those services. Clearly connecting what was donethe procedure codewith why
it was donethe diagnosis codeis essential for maximum appropriate reimbursement. For this
reason, patient account specialists need to understand the basics of the medical coding process.
As explained in Chapter 1, HIPAA mandates certain medical code setsstandardized alphabetic and/or numeric representations of datafor use in health care transactions. Table 4.1
summarizes the three classifications.