The question posed in the headline of this blog post — what does a medical coder do? — is an interesting one in several different ways.

It’s an interesting question because even the most straightforward answer has surprising wrinkles.

Medical coders work in the billing department of physician’s offices, hospitals, and other health care facilities. Medical coders assign medical billing codes for various treatments and procedures. This coding process expedites and standardizes billing procedures according to industry-recognized medical billing coding systems.

“A medical coder is responsible for translating patient data into standard medical codes,” writes Pioneer Pacific College (in a piece that’s worth quoting at length), “as well as organizing and maintaining medical records of hospital and/or clinic patients by electronically recording data to be stored in clinical databases and accessed for analysis and reporting. Medical coders compile and maintain patient data for clinical databases and registries, meeting regulatory and ethical requirements of the healthcare system. They also track patient outcomes for quality assessment and ensure the confidentiality of patients’ records.”

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.”

Medical Codes

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-10. 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.

Patients, healthcare providers, insurance companies, medical billers (whose responsibilities are different than but similar to coding jobs), and highly regarded companies, such as MBA Medical … these are all pieces of the enormous American health care puzzle.