Summary

The medical coding market was valued at USD 15,259.67 million in 2020, and it is expected to reach USD 28,363.63 million by 2026, registering a CAGR of 10.93%, during the forecast period.

As per the WHO, in February 2020, emergency codes were activated for COVID-19 for the confirmed diagnosis of COVID-19 ​and for clinical or epidemiological diagnosis (suspected or probable) of COVID-19​. In April 2020, the international guidelines for certification and classification (coding) of COVID-19 as the cause of death were published in 7 languages. ​In January 2021, a set of additional codes was activated for immunization to prevent COVID-19 and for adverse reactions to a COVID-19 vaccine.

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. The agency recently 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 new FDA guidelines.

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

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. The 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.

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. For instance, like government agencies tracking the incidence of a certain disease, medical facilities can track the efficiency of their practice by analyzing.

Moreover, 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. In August 2019, Aviacode launched its new website at www.aviacode.com that features a comprehensive offering of its medical coding, auditing, and global revenue cycle management services. However, continuously changing regulations, data security concerns, and the lack of IT professionals in the healthcare sector are expected to hinder the market growth.

Key Market Trends

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

The international classification of diseases (ICD) segment is expected to register a significant share, in terms of revenue, over the forecast period, owing to the increasing demand for trained medical coders. 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. 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. Moreover, with the improving versions of ICD, its usage is expected to rise, as the newer versions provide more information than the previous ones further. 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. Hence, this segment is expected to grow in the future due to the rising growth of medical coding across the world.

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. According to the American Heart Association Research Report 2018, heart diseases account for 1 in 7 deaths in the United States. In 2018, coronary heart disease was the leading cause (43.8%) of deaths attributable to cardiovascular disease in the United States, followed by stroke (16.8%), heart failure (9.0%), high blood pressure (9.4%), diseases of the arteries (3.1%), and other cardiovascular diseases (17.9%).

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 proprietory 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 both 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. In April 2020, Aidéo Technologies announced that it would allow healthcare organizations and revenue cycle management companies to utilize its AI-enabled medical coding engine Gemini AutoCode free of charge in response to COVID-19. 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 INTRODUCTION
1.1 Study Assumptions and Market Definition
1.2 Scope of the Study

2 RESEARCH METHODOLOGY

3 EXECUTIVE SUMMARY

4 MARKET DYNAMICS
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
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
5.4.1.1 United States
5.4.1.2 Canada
5.4.1.3 Mexico
5.4.2 Europe
5.4.2.1 Germany
5.4.2.2 United Kingdom
5.4.2.3 France
5.4.2.4 Italy
5.4.2.5 Spain
5.4.2.6 Rest of Europe
5.4.3 Asia-Pacific
5.4.3.1 China
5.4.3.2 Japan
5.4.3.3 India
5.4.3.4 Australia
5.4.3.5 South Korea
5.4.3.6 Rest of Asia-Pacific
5.4.4 Middle-East and Africa
5.4.4.1 GCC
5.4.4.2 South Africa
5.4.4.3 Rest of Middle-East and Africa
5.4.5 South America
5.4.5.1 Brazil
5.4.5.2 Argentina
5.4.5.3 Rest of South America

6 COMPETITIVE LANDSCAPE
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 nThrive (Precyse Solutions LLC)
6.1.11 The Coding Network LLC

7 MARKET OPPORTUNITIES AND FUTURE TRENDS