Medical coding is the process of translating signs, symptoms, diagnoses, and procedures documented by a healthcare provider in the patient’s record into alphanumeric codes in order to facilitate correct billing and classification. Standard codes are used by healthcare organizations to refer to specific diseases and procedures. Diseases are coded using the International Classification of Diseases, 9th Edition (ICD-9) Clinical Modification (ICD-9-CM) which is maintained by the Centers for Medicare & Medicaid Services (CMS). ICD-9-CM is a adaptation of the full ICD-9 which is released annually by the World Health Organization. Procedures are coded using Current Procedural Terminology (CPT) and the Healthcare Common Procedure Coding System (HCPCS) code sets. CPT is maintained by the American Medical Association, while HCPCS is maintained by the CMS.
02The billing process starts with an encounter between a patient and his healthcare provider. The provider documents this encounter in a medical record. Whatever happens during this encounter will be the basis for the services billed. The patient’s record is processed by a medical coder. Diagnoses and procedures documented by the provider in the record will be translated into alphanumeric codes from ICD-9-CM, CPT, and HCPCS. On the other hand, the patient’s bill is processed by a medical biller. Codes are entered into the necessary forms for submission to the concerned agencies, such as private insurers, Medicare/Medicaid, or their authorized vendors. Insurers process the physician office’s claim and assess whether the claims are valid or not. Valid claims are reimbursed according to how the physician’s office billed the services, which ultimately are the product of the coder’s work. Denied claims are not reimbursed, in which case the patient can file an appeal.
03Medical coding is the process of translating patients’ diagnosis, procedures, and supplies information from the medical record into alphanumeric codes in order to facilitate and standardize the billing forms of doctors’ offices. The US government has mandated these standardized codes, and they have a deadline to comply by 2014 or else face huge fines. Because US health workers are expensive to retain for such non-clinical tasks, doctors’ offices and insurance companies have turned to outsourcing these tasks to India and the Philippines. It has been projected by the US Bureau of Labor Statistics that between 2008 and 2018, there will be a demand for 35,000+ workers to do medical coding and billing tasks.
04Medical coding and billing deal with medical information – data from medical records are gathered, analyzed translated into alphanumeric codes. These codes are organized and included in the claims form sent for reimbursement purposes. Coders are tasked to ensure that the correct codes are assigned for the diagnoses and procedures found in a patient’s chart, so that healthcare providers to receive proper payment for the services they rendered to the patient. Coding errors may lead to either underpayment or nonpayment by the physician, or suspicion of fraud. Billers, on the other hand, prepare the paperwork that includes the codes and submit these to the proper agencies for reimbursement. The tasks of the coder and biller may be performed by the same person or distributed to different members of a team. Coders may work either from home or within the office. Coders and billers are generally employed by coding/billing companies.
05Anyone with knowledge of medical terminology, anatomy, and pathophysiology and able to learn the principles of coding and billing can apply for a billing/coding job. People with clinical experience have an advantage because they already have the knowledge of medical concepts and experience in handling patient records/charts. However, those who have no previous experience or knowledge can enroll in medical terminology, anatomy, and pathophysiology courses to enhance their knowledge.
06This certification is conferred by the American Academy of Professional Coders (AAPC) and is the gold standard in coding for physician offices. CPC®s usually earn 20% higher than non-certified coders, and are more likely to be retained or promoted by healthcare employers.
07This certification is conferred by the American Academy of Professional Coders (AAPC) and is the gold standard in coding for physician offices. CPC®s usually earn 20% higher than non-certified coders, and are more likely to be retained or promoted by healthcare employers.
08Have an advanced working knowledge of medical terminology, anatomy and physiology
