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Medical Coding Market - Growth, Trends, COVID-19 Impact, and Forecasts (2022 - 2027)

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  • 129 Pages
  • August 2022
  • Region: Global
  • Mordor Intelligence
  • ID: 5176098
UP TO OFF until Sep 30th 2022
The medical coding market was valued at USD 16,885.09 million in 2021, registering a CAGR of 10.93% during the forecast period.

The COVID-19 pandemic has significantly impacted the healthcare systems across the world. As per the World Health Organization (WHO), in February 2020, emergency codes were activated for COVID-19 for the confirmed diagnosis of COVID-19 ​and clinical or epidemiological diagnosis (suspected or probable) of COVID-19​. Also, in April 2020, the international guidelines for certification and classification (coding) of COVID-19 as the cause of death were published in 7 languages by the WHO. Moreover, the Centers for Medicare and Medicaid Services (CMS) has been at the forefront of helping providers handle the medical billing and coding aspect of COVID-10 testing and treatment. In March 2020, the CMS released two Healthcare Common Procedure Coding System (HCPCS) codes that laboratories can use to bill for certain COVID-19 diagnostic tests, including those developed in-house according to the new United States Food and Administration (USFDA) guidelines.

The factors responsible for the market growth include the escalating demand for coding services, the rising need for a universal language to reduce frauds and misinterpretations associated with insurance claims, and the high demand for streamlining hospital billing procedures.

The demand for coding services is significantly increasing. For instance, as per the American Hospital Association (AHA) Hospital Statistics 2021 report, around 36,241,815 admissions were reported in all the hospitals in the United States in 2020. There is a high demand for medical billers and coders in the market studied. As per the 2022 American Academy of Professional Coders (AAPC), there are thousands of services performed by providers and an equal number of injectable drugs and supplies to be tracked, and medical coding classifies these for easier reporting and tracking. The AAPC also states that in healthcare, there are multiple descriptions, acronyms, names, and eponyms for each disease, procedure, and tool, and medical coding standardizes the language and presentation of all these elements, so they can be more easily understood, tracked, and modified. Thus, coding-related jobs have been expanding due to the growing landscape of the business side of healthcare and their efficiency to automate large amounts of work. For instance, as per the November 2021 update by the United States Bureau of Labor Statistics, the number of positions for medical records and health information specialists, including medical coders, will increase to 37,000, i.e., 9% between 2020 and 2030.

Moreover, there is also a demand to switch to a more streamlined and convenient coding and billing solution. Medical coding also enables uniform documentation between medical facilities. The medical coding companies enable administrations to look at the incidence and effectiveness of treatment in their facility. This is particularly important to large medical facilities, like tertiary-care hospitals. Thus, frequent launches in the respective market are expected to drive the market. In March 2021, athenahealth launched athenaOne Medical Coding Solution, an EHR coding solution that could mitigate clinician coding-related work and ultimately reduce clinician burnout. Also, as per a 2022 update by the American Medical Association (AMA), in January 2022, new current procedural terminology (CPT) codes have been created that streamline the novel coronavirus testing currently available in the US market.

However, continuously changing regulations, data security concerns, and the lack of adequately equipped information technology (IT) professionals in the healthcare sector are expected to hinder the market growth.

Key Market Trends

The International Classification of Diseases (ICD) Segment is the Largest Segment and is Expected to Grow During the Forecast Period

The international classification of diseases (ICD) segment is expected to hold a significant share, in terms of revenue, over the forecast period. This can be attributed to the increasing demand for trained medical coders due to a growing prevalence of diseases. The international classification of diseases (ICD) is referred to as a diagnostic tool for epidemiology, health management, and clinical purposes. The ICD is maintained by the WHO. Thus, the increasing prevalence of chronic diseases is expected to boost the growth of this segment. For instance, according to the June 2021 Update by the World Health Organization (WHO), cardiovascular diseases (CVDs) are the number one cause of death globally, taking an anticipated 17.9 million lives each year. According to the January 2022 update by the British Heart Foundation (BHF), around 4 million males and 3.6 million females are living with heart and circulatory diseases in the United Kingdom. As the ICD provides a method of diagnostic codes for classifying diseases, the high prevalence of CVDs will boost the market growth.

Moreover, with the improving versions of ICD, its usage is expected to rise, as the newer versions provide more information than the previous ones. The version of ICD-11 was released in June 2018 to allow member states to prepare for implementation, including translating ICD into their national languages. The ICD-11 version is a substantial improvement of the ICD-10 version; it has 55,000 unique codes for injuries, diseases, and causes of death compared to that of 14,400 in ICD-10. This ICD-11 version may be effective from 2022. This release is an advance preview that may allow countries to plan how to use the new version, prepare translations, and train health professionals all across the country. Also, as per an October 2021 update by the CMS, in response to the national emergency that was declared concerning the COVID-19 outbreak, the Centers for Disease Control and Prevention’s (CDC) National Center for Health Statistics (NCHS) is implementing six new diagnosis codes into the International Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10-CM). Hence, this segment is expected to grow in the future due to the rising growth of the medical coding market.

North America is the Biggest Market and is Expected to Show a Similar Trend Over the Forecast Period

The North American market is estimated to hold the largest share, in terms of revenue, over the forecast period, owing 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 and a growing number of chronic diseases in the country, which is anticipated to stimulate the demand in this region. As per the September 2021 update by the Centers for Disease Control and Prevention (CDC), coronary heart disease is the most common type of heart disease, killing 360,900 people in 2019 in the United States. Also, the American Heart Association reports that nearly half of Americans have some kind of cardiovascular diseases, including hypertension, coronary heart disease, and other diseases.

Many companies in the region are either launching new products or are entering into strategic initiatives to boost their market share. For instance, in November 2020, WELL Health Technologies Corp. announced the acquisition of Toronto-based DoctorCare. The proprietary technology of DoctorCare was used to minimize errors, ensure compliance with complicated medical billing claim codes, and help improve patient care.​ Furthermore, in June 2020, Shockwave Medical Inc. announced that the Centers for Medicare & Medicaid Services (CMS) issued new codes for intravascular lithotripsy (IVL) procedures performed for peripheral arteries in inpatient and outpatient settings. Moreover, in the United States, 3M offers a next-generation coding and reimbursement solution powered by the 3M 360 Encompass System. Therefore, the high demand for specialist coders and a favorable healthcare system are the key factors anticipated to drive the market growth.

Competitive Landscape

The number of professional coders is expected to rise significantly over the forecast period, thus boosting the number of companies providing platforms for medical coding professionals. Hence, the market seems to be highly fragmented due to the presence of many local providers offering a wide array of services, and all the players are adopting various growth strategies to enhance their market presence. Some of the key players in the market studied are Oracle, Nuance, the Coding Network, and Optum.

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Table of Contents

1.1 Study Assumptions and Market Definition
1.2 Scope of the Study
4.1 Market Overview
4.2 Market Drivers
4.2.1 Escalating Demand for Coding Services
4.2.2 Rising Need for a Universal Language to Reduce Frauds and Misinterpretations Associated with Insurance Claims
4.2.3 High Demand to Streamline Hospital Billing Procedures
4.3 Market Restraints
4.3.1 Changing Regulations Related to Medical Coding
4.3.2 Data Security Concerns
4.3.3 Lack of Adequately Equipped IT Professionals
4.4 Porter's Five Forces Analysis
4.4.1 Threat of New Entrants
4.4.2 Bargaining Power of Buyers/Consumers
4.4.3 Bargaining Power of Suppliers
4.4.4 Threat of Substitute Products
4.4.5 Intensity of Competitive Rivalry
5 MARKET SEGMENTATION (Market Size by Value - USD Million)
5.1 By Classification System
5.1.1 International Classification of Diseases (ICD)
5.1.2 Healthcare Common Procedure Code System (HCPCS)
5.2 By Component
5.2.1 In-house
5.2.2 Outsourced
5.3 By End User
5.3.1 Hospitals
5.3.2 Diagnostic Centers
5.3.3 Other End Users
5.4 By Geography
5.4.1 North America United States Canada Mexico
5.4.2 Europe Germany United Kingdom France Italy Spain Rest of Europe
5.4.3 Asia-Pacific China Japan India Australia South Korea Rest of Asia-Pacific
5.4.4 Middle-East and Africa GCC South Africa Rest of Middle-East and Africa
5.4.5 South America Brazil Argentina Rest of South America
6.1 Company Profiles
6.1.1 3M Company
6.1.2 Aviacode Inc.
6.1.3 Dolbey Systems Inc.
6.1.4 Maxim Health Information Services
6.1.5 MRA Health Information Services
6.1.6 Nuance Communications Inc.
6.1.7 Optum Inc.
6.1.8 Oracle Corporation
6.1.9 Talix
6.1.10 The Coding Network LLC
6.1.11 Precyse Solutions LLC
6.1.12 Access Healthcare
6.1.13 Global Healthcare Resource
6.1.14 Episource
6.1.15 Omega Healthcare

Companies Mentioned

A selection of companies mentioned in this report includes:

  • 3M Company
  • Aviacode Inc.
  • Dolbey Systems Inc.
  • Maxim Health Information Services
  • MRA Health Information Services
  • Nuance Communications Inc.
  • Optum Inc.
  • Oracle Corporation
  • Talix
  • The Coding Network LLC
  • Precyse Solutions LLC
  • Access Healthcare
  • Global Healthcare Resource
  • Episource
  • Omega Healthcare