U.S. Medical Coding Market Size, Share & Trends Report

U.S. Medical Coding Market Size, Share & Trends Analysis Report By Classification System (ICD, HCPCS, CPT), By Component (In-house, Outsourced), And Segment Forecasts, 2019 - 2025

  • Published Date: Jan, 2019
  • Base Year for Estimate: 2017
  • Report ID: GVR-3-68038-025-5
  • Format: Electronic (PDF)
  • Historical Data: 2014 - 2016
  • Number of Pages: 80

Industry Insights

The U.S. medical coding market size was valued at USD 3.4 billion in 2017 and is anticipated to witness a CAGR of 9.3% over the forecast period. Rising importance of evidence-based medicine, pharmacoeconomic risk benefit analysis of different drugs and medical devices, and insurance settlements are major factors driving the growth of this market. Although the healthcare industry is restricted by stringent regulatory protocols, social media is creating a significant impact on modern healthcare. Many developed economies, such as U.S., are extensively using social media for increasing the awareness about advanced healthcare.

The introduction of social media analytics is anticipated enhance the efficiency in healthcare analytics. Moreover, with the advent of data enrichment tools, such as Electronic Health Records (EHRs), mHealth, and mobile application, the communication gap between caregivers and patients has decreased significantly. These tools generate tremendous amount of data, which can be used for personalized treatment after translating them into coded language.

U.S. Medical Coding Market

It can also be used for increasing the efficiency of various procedures including insurance claims, healthcare analytics, and medical billing. To combat the issue of rise in the number of cybercrimes, Health Insurance Portability and Accountability Act (HIPAA) was incorporated in 1996. It protects the patient rights in terms of confidentiality of information. The U.S. government also introduced the Health Information Technology for Economic and Clinical Health Act (HITECH Act) in 2009.

The violation of this act may lead to monetary fines up to USD 4.0 million. A number of developing, as well as developed, regions are focused on providing cost-effective and high-quality healthcare solutions. U.S. spends approximately 2.4 times of the global average healthcare spending. This is expected to rise by more than 68% in coming decade. With the help of medical coding, providers are now able to offer right treatment at effective prices.

Classification System Insights

Based on classification system, the U.S. medical coding market is segmented into International Classification of Diseases (ICD), Healthcare Common Procedure Coding System (HCPCS), and Current Procedural Terminology (CPT) medical coding systems. ICD is the standard system for the classification of mortality and morbidity statistics and the segment is anticipated to witness the fastest CAGR during the forecast period. Current version of ICD contains around 69,823 codes for diagnostics and 71,924 codes for procedures.

Addition of more than 140,000 new codes in the near future is expected to boost the demand for trained coders, thereby augmenting the market growth. CPT is a part of HCPCS codes. They are used to describe surgeryies tests, and other medical procedures. These codes are extensively used in billing processes and are usually tracked by the government to assess parameters, such as healthcare spending and disease prevalence. HCPCS is used by Medicare, Medicaid, and other third-party health insurance providers for systematic and timely management of healthcare claims. Under HIPAA, the U.S. government has mandated the use of HCPCS code.

Component Insights

Based on component, the market is fragmented into in-house and outsourced medical coding services. The preference for these services differ from business to business and are dependent upon various factors including availability of skilled labor and healthcare system in the country.

U.S. medical coding market share

The outsourced medical services segment dominated the overall market in the past. The outsourcing contract is usually signed for specific time period, such as for a few months or years. These service systems are associated with reduced training costs, improved quality, and enhanced consistency as compared to the in-house services.

U.S. Medical Coding Market Share Insights

As most of the medical coding services are outsourced, the market is highly fragmented. Some of the key companies providing platforms for coders to engage with healthcare service providers and insurance providers are STARTEK Health; Oracle Corporation; Maxim Health Information Services; Verisk Analytics; Aviacode, Inc.; Parexel International Corporation; Precyse Solutions, LLC.; and Medical Record Associates LLC. These industry participants have undertaken several business strategies to gain comnpetitive edge over others. For example, Medical Record Associates acquired TrustHCS’s cancer research division to expand its cancer registry offerings.

Report Scope

Attribute

Details

Base year for estimation

2017

Actual estimates/Historical data

2014 - 2016

Forecast period

2018 - 2025

Market representation

Revenue in USD Million and CAGR from 2018 to 2025

Report coverage

Revenue forecast, company share, competitive landscape, growth factors and trends

Country scope

U.S.

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Segments Covered in the Report

This report forecasts revenue and volume growth at country level and provides an analysis of the latest industry trends in each of the sub-segments from 2014 to 2025. For the purpose of this study, Grand View Research has segmented the U.S. medical coding market report on the basis of classification system and component:

  • Classification System Outlook (Revenue, USD Million, 2014 - 2025)

    • ICD

    • HCPCS

    • CPT

  • Component Outlook (Revenue, USD Million, 2014 - 2025)

    • In-house

    • Outsourced

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