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
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.
Article: What Does a Medical
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®).
What Education and Medical Coding Training is Required to Become a Medical Coder?
While many coding professionals have strengthened their career by earning their bachelor’s
degrees and master’s degrees, neither is required for a career in medical coding. What
is required is a solid understanding of anatomy, physiology and medical terminology. It is
also highly recommended for serious coders to complete a medical coding course of study,
pass the CPC exam and earn their certification as
a Certified Professional Coder, or CPC®. Certified Professional Coders, or CPCs®,
are in high demand because employers know that these individuals can perform the job of medical
coder with the utmost proficiency.
Today more than 121,000 medical professionals are members of AAPC. This professional
association provides a variety of opportunities to elevate the standards of medical coding
by developing training, professional certification, opportunities to network with
other related medical professionals and a variety of job
search database and career building opportunities. Learn more about AAPC and take advantage
of the workshops, on-demand
webinars, regional and national conferences,
and the monthly magazine, Coding
Edge to develop your skills and stand out in your field. As a member of AAPC you
will also be able to meet other coding professionals by participating in the coding
discussion forums, Facebook group, or one
of more than 550 local chapters throughout the United
States and outlying areas. AAPC members also enjoy huge
savings on medical coding books as well as a variety of other members-only
Since its inception more than 20 years ago AAPC has developed a wide variety of professional
credentials allowing its members to stand out amongst their peers and validate their
expertise in a variety of fields. Coders may choose to broaden their skills by extending
into medical auditing, compliance, out-patient practice, or practice management. Others
may choose to complete a medical coding training course or specialize by earning one
of AAPC’s specialty credentials.
The AAPC credential is recognized nationally by employers, medical societies and government
organizations. They are a great way to start a career in medical coding and the recent medical
coding salary survey suggests that AAPC certified coders earn significantly more than non-credentialed
Where Do I Begin?
If you are interested about what you have read so far about AAPC and opportunities pursuing
medical coding, medical auditing, practice management, compliance, or one of the other specialized
credentials you can start your new career by joining AAPC or
by registering for one of the medical coding training courses today.