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.

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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.

Article: What Does a Medical Coder Do?

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.

No earlier than October 1, 2015 the United States will adopt the latest version of medical codes by updating to ICD-10. Last updated in 1977 the new ICD-10 will increase the number of codes from approximately 13,600 to more than 144,000.

Read More: How the Transition from ICD-9 to ICD-10 will Affect Coding and the Medical Community

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 128,000 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, Healthcare Business Monthly 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 exclusive discounts.

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 coders.

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.