Global Medical Coding Market - 2022-2029

Global Medical Coding Market - 2022-2029

Market Overview

Medical Coding Market is expected to grow at a high CAGR of 10.5% during the forecasting period (2022-2029).

Medical coding is the transformation of healthcare procedures, medical services, equipment, and diagnosis into universal medical alphanumeric codes. A medical coder receives the report from doctors, which may include the patient’s condition, diagnosis performed, prescription, and all the procedures and tests conducted by healthcare professionals/providers on the patients, and transforms the details into a set of codes. This set of codes is mostly used for claim management, data that are used by emergency response systems, and clinical decisions support systems by emergency clinics.

The Medical Coder may be the same person which ensures the invoices are paid properly. To help promote a smooth coding and billing process, the coder checks the patient’s medical record (i.e., the transcription of the doctor’s notes, ordered laboratory tests, requested imaging studies, and other sources) to verify the work that was done. Both work together to avoid insurance payment denials. The results are submitted to payers for reimbursement, but the data derived from the codes also are used to determine utilization, manage risk, identify resource use, build actuarial tables, and support public health and actions.

Market Dynamics

The market is driven is the rising in the implementation of IT in healthcare settings and the advantages of medical coding for different aspects of healthcare settings such as claim management, feeding data clinical decision support systems, and emergency decision support systems. Increasing demand for universal language in medical documents to streamline hospital billing procedures is also expected to drive the market during the forecast period. There is a high demand for medical billers and coders in the current job market. Thus, coding-related jobs are expanding, due to the growing landscape of the business side of healthcare, along with their efficiency to automate large amounts of work. Hence, the escalating demand for coding jobs is likely to drive the market studied across the world. The technological advancements in the healthcare industry and constantly changing classification systems are expected to create potential revenue opportunities for players operating in the target market over the forecast period. Also, the escalating demand for coding services, rising need for a universal language to reduce frauds and misinterpretations associated with insurance claims, and high demand to streamline hospital billing procedures. In addition, data security is a major concern for healthcare organizations, and offshore coding companies are also becoming aware of these data security concerns while understanding that a breach in a client's data is likely to result in the loss of business. Thus, leading offshore coding firms are building a secure environment for the coders to work in. However, cyber threats and insecurity among healthcare providers and patients are expected to hamper the market during the forecast period.

The recent outbreak of the COVID-19 pandemic is likely to act as a major restraint to the market. Most of the projects in China, the US, Germany, and South Korea are delayed, and the companies are facing short-term operational issues due to supply chain constraints and lack of site access due to the COVID-19 outbreak. This factor is a major restraint of the global medical coding market in the forecast period.

Market Segmentation:The International Classification of Diseases (ICD) for the highest share in global medical coding market

The global medical coding market is segmented based on classification system by International Classification of Diseases (ICD), Healthcare Common Procedure Code System (HCPCS), Tenth Revision, Clinical Modification (ICD-10-CM). The International Classification of Diseases (ICD) segment held the largest market share owing to the increasing demand for trained medical coders. ICD is maintained by the World Health Organization and modified by each member country to serve its needs.

The ICD has diverse clinical applications and is used not just by doctors but also by paramedic staff, insurance companies, researchers, and policymakers. ICD is used to classify diseases and store diagnostic information for clinical, quality, and epidemiological purposes and also for reimbursement of insurance claims. ICD is the foundation for the identification of health trends and statistics globally. It is the diagnostic classification standard for all clinical and research purposes. ICD defines the universe of diseases, disorders, injuries, and other related health conditions, listed in a comprehensive, hierarchical fashion that allows for easy storage, retrieval, and analysis of health information for evidence-based decision-making, sharing and comparing health information between hospitals, regions, settings, and countries, and data comparisons in the same location across different periods.

Uses include monitoring the incidence and prevalence of diseases, observing reimbursements and resource allocation trends, and keeping track of safety and quality guidelines. They also include the counting of deaths as well as diseases, injuries, symptoms, reasons for encounters, factors that influence health status, and external causes of disease.

The need for ICD is increasing across the world, owing to a growing prevalence of diseases. According to the World Health Organization (WHO), cardiovascular diseases is the number one cause of death globally, taking an anticipated 17.9 million lives each year and it is approximately 32 percent of all deaths worldwide.

According to the British Heart Foundation (BHF), 17, 06,213 cases of cardiovascular diseases are diagnosed in the United Kingdom alone. As per the statistics, the incidence of cardiovascular diseases is increasing, which is directly proportional to the market growth. Hence, this segment is expected to grow in the future, due to the rising growth of medical coding across the world.

The Healthcare Common Procedure Code System (HCPCS) segment is expected to have positive market growth in the forecast period. The Healthcare Common Procedure Coding System (HCPCS) is a collection of codes that represent procedures, supplies, products, and services that may be provided to Medicare beneficiaries and individuals enrolled in private health insurance programs.

Each year, in the United States, health care insurers process over 5 billion claims for payment. For Medicare and other health insurance programs to ensure that these claims are processed in an orderly and consistent manner, standardized coding systems are essential. The HCPCS Code Set is one of the standard code sets used for this purpose. This factor will drive the growth of the market in the forecast period.

Further, the market is also classified based on the end-user as hospitals, diagnostic centers, and others. The hospital's segment is held the largest market share. Medical coding is used to store record-keeping for hospital operations review and planning, and perhaps most importantly, for financial reimbursement purposes. The evaluation and management codes are important for correctly reimbursing the physician and the hospital. This factor is driving the growth of the market in the forecast period. Geographical Penetration: North America is the dominating region during the forecast period.

By region, the medical coding market is segmented into North America, South America, Europe, Asia-Pacific, Middle-East, and Africa. Among all of the regions, North America dominated the global medical coding market and is expected to grow at the highest CAGR during the forecast period due to technological advancements and improved healthcare infrastructure in various countries in this region.

In the North American region, the United States holds the largest market share due to factors, such as an increasing geriatric population, along with a growing number of chronic diseases in the country, which is anticipated to stimulate the demand in this region. According to the Centers for Disease Control and Prevention, one person dies every 34 seconds from cardiovascular disease in the United States. In 2020, about 697,000 people in the United States died from heart disease that indicates 1 in every 5 deaths. Therefore, the high demand for specialist coders and the presence of a favorable healthcare system are the key factors that are anticipated to drive the market growth.

North America’s dominance is attributed to the implementation of ICD codes and the rising number of hospitalizations in the region. The current version of the ICD contains around 69,823 codes for diagnostics and 71,924 for procedures. The addition of more than 140,000 new codes from its previous version is expected to significantly increase demand for trained coders, thus boosting the segment in the region.

The Asia-Pacific region is expected to have the third-largest share due to the higher growth rate is attributed to increasing healthcare IT spending and rising number of medical coding outsourcing companies in countries such as Japan, China, and India, increasing outsourcing of medical coding projects from developed countries such as U.S. and countries in Europe. Furthermore, expansion of Europe- and U.S.-based companies in the region through mergers & acquisitions or subsidiary establishment will drive the growth of the market in the forecast period.

Competitive Landscape:

The medical coding market is highly competitive with the presence of several international and local markets. Product diversification, revenue generation, and opportunities intensify the market competition STARTEK Health, Aviacode, Inc., Parexel International Corporation, Maxim Health Information Services, Precyse Solutions, LLC, and Medical Record Associates LLC. are the leading market players with significant market share. The major players are using product development, novel product launches, market expansion, and product diversification strategies for holding their position in the market.

The companies are entering into collaborations, mergers, strategic partnerships, and acquisitions to expand their presence and meet the rising demand for medical coding across the globe. For instance, in August 2021, Gebbs healthcare solutions is a provider solution of medical billing and medical coding. It has the acquisition of Aviacode Medical Coding & Coding Audit Services. Aviacode is a US-based company located in Hyderabad in the Health Information Management (HIM) space. With the acquisition of Aviacode medical coding, GeBBS will further consolidate its position as a leader in the health information management space.