(Updated July 14, 2022)
The question posed in the headline of this blog post — what does a medical coder do? — is an interesting one in several different ways. Even the most straightforward answer has surprising wrinkles.
Medical coders work in hospitals, physician’s offices, and other health care facilities as part of the billing department. Medical coders assign medical billing codes for various treatments, procedures, other medical services, and equipment. This coding process expedites and standardizes billing procedures according to industry-recognized medical billing coding systems.
Certified professional coders basically provide a link from the services provided by a healthcare professional to the business side of the industry. If you see your doctor about a knee replacement, coders take that information and assign it the appropriate code. Billers then take that code and apply costs.
By tracking visits, diagnoses, and procedures, medical coders ensure all information is easily accessible by facilities around the world. They are also charged with assigning the appropriate codes for durable medical equipment and ensuring personal information on the medical record is correct.
About Those Wrinkles
What about those surprising wrinkles that we mentioned above? Those appear out of necessity for coding professionals. As we’ve written in a previous blog post, medical coders “act like translators by taking medical reports that are provided by physicians and turning the information found on those reports into a set of universal medical alphanumeric codes.”
In addition to being absolutely efficient and accurate when entering correct codes, a medical coding specialist must remain aware of — and in front of — changes and updates to billing code practices.
“Since medical codes change all the time,” we wrote in our “What is Medical Coding?” blogpost, “coders face a challenging job that requires an understanding of medical terminology and a willingness to always learn something new.”
These codes are changed or amended quite often to reflect changes in the healthcare industry. It’s not that there are suddenly new diseases or illnesses, but rather, medical conditions are re-classified or are recognized by the medical community. The classification systems adapt to these additions.
The 11th iteration of the ICD codes includes new ways to classify gender incongruence, sexual dysfunctions, and STIs as well as neurodevelopmental disorders dealing with sexual behavior, gaming addictions, and other impulse control disorders. These additions increased the number of codes by five times!
For the last few decades, there have been three main medical code sets for professional coders:
International Classification of Diseases (ICD) codes, based on the World Health Organization. Its full name is a mouthful: the International Statistical Classification of Diseases and Related Health Problems. They are better known by the acronym ICD-11. They represent virtually any medical condition a patient may have.
Current Procedure Terminology (CPT) codes set by the American Medical Association. These codes represent nearly all of the services a healthcare provider is likely to perform.
Healthcare Common Procedure Coding System (HCPCS) codes. These are an extension of the CPT codes, with the addition of payer-specific codes and codes for supplies and drugs.
There’s a lot to think about when it comes to modern health care in the United States. Things are changing rapidly as politicians and their constituents work together to build a health care system that works for everybody. One way of doing that is turning medical reports for services and medical equipment into universal medical codes that are easily transferable.
Patients, healthcare providers, insurance companies, medical billers (whose responsibilities are different but similar to coding jobs), and highly regarded companies, such as MBA Medical, are all pieces of the enormous American health care puzzle.
We provide staff support, training programs, and medical coding and billing services, allowing health care professionals to focus on their patients and their needs. We reduce revenue cycle times, lost income, and billing inconsistencies, allowing you to maximize your bottom line.
MBA Medical also provides consulting, credentialing, bookkeeping, and other services that help keep your practice running smoothly. We also offer medical IT services as well as medical SEO to make your website easier to find. MBA Medical services will take care of the business office while you take care of your patients.