What is Medical Coding?

Medical coding professionals provide a key step in the medical billing process. Every time a patient receives professional health care in a physician’s office, hospital outpatient facility or ambulatory surgical center (ASC), the provider must document the services provided. The medical coder will abstract the information from the documentation, assign the appropriate codes, and create a claim to be paid, whether by a commercial payer, the patient, or CMS.

Is Medical Coding the same as Medical Billing?

No. While the medical coder and medical biller may be the same person or may work closely together to make sure all invoices are paid properly, the medical coder is primarily responsible for abstracting and assigning the appropriate coding on the claims. In order to accomplish this, the coder checks a variety of sources within 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. Then the coder must assign CPT® codes, ICD-9 codes and HCPCS codes to both report the procedures that were performed and to provide the medical biller with the information necessary to process a claim for reimbursement by the appropriate insurance agency.

There is a great deal of diversity among the numerous claims a medical coder processes on a daily basis. While codes vary a great deal in breadth and specificity, the following article represents what a sample medical coding transaction may look like.

It takes a good deal of education and training to become a skilled medical coder. To begin, coders must have a thorough knowledge of anatomy and medical terminology. It is also important to become familiar with different types of insurance plans, regulations, compliance,  and the coding community’s three critical resource books: CPT®, HCPCS Level II and ICD-9-CM along with their corresponding codes and guidelines.

Using code books the medical coder assigns correct codes to record the service levels for the procedures performed and to account for supplies used to treat the patient during an encounter with the physician. Proper assignment of ICD-9-CM codes corresponds with the physician’s diagnoses and completes the “story” of the patient’s illness or injury.

In addition to assigning ICD-9, CPT®, and HCPCs codes, today’s medical coder may be involved in a wide variety of coding-related activities. The coder may audit and re-file appeals of denied claims. The coder may also educate providers and recommend the appropriate application of federal mandates and compliance that require providers to use specific coding and billing standards through chart audits. He/She may also act as an advocate for the provider and patient in issues of coverage and medical necessity. Starting a career in medical coding opens a number of coding-related jobs like Certified Professional Medical Auditor (CPMA®), Certified Professional Compliance Officer (CPCO™), and Certified Physician Practice Manager (CPPM®).

To get more familiar with this heavy topic please visit the basics at http://en.wikipedia.org/wiki/Medical_classification

http://www.aapc.com/medical-coding/medical-coding.aspx

or for the latest trends http://www.emrnews.com/medical-coding-latest-trends/

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