Medical coder 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.
Information on medical reports include prescriptions, medical diagnoses, any medical procedures performed on the patient, and the patient’s condition.
Medical coders are responsible for making sure these codes are correctly applied during the medical billing process. In addition to assigning the correct codes, they create a claim to be paid by insurance providers.
Medical Coding vs Medical Billing
These two healthcare professions are often confused. They are both involved with administrative tasks, but medical billing and medical coding require their own unique skill sets.
While medical coders translate patient care into current procedural terminology (CPT) codes, medical billers create a claim based on the codes provided by medical coders.
While they have distinct skillsets, there are times when the same person may perform both duties. Medical coders and medical billing professionals work together to avoid insurance payment denials. They both also process a number of medical services and claims each day.
The medical coder’s job is to paint a complete picture of each patient’s interaction with a physician. It needs to be as specific as possible in order to avoid the risk of miscommunicating what services were rendered and capture timely reimbursement for those services. In order to achieve this goal, medical coders must review clinical statements and assign the correct standard codes, rather than listing the actual information.
There are three sets of code medical coders use:
ICD codes – International Classification of Diseases (ICD codes) establish a uniform vocabulary that describes the causes of injury, illness and death.
CPT codes – Current Procedure Terminology (CPT codes) document most medical procedures performed in a doctor’s office. CPT codes are set by the American Medical Association (AMA).
HCPCS codes – Healthcare Common Procedure Coding System (HCPCS) is based on CPT codes. They primarily correspond with services, procedures and equipment not covered by CPT codes.
Medical coders do not simply list things that take place between a doctor and their patient, such as procedures, symptoms and diagnoses. When a patient’s condition is more complex, the amount of information that needs to be submitted becomes much greater.
With the potential of more than a billion doctor visits every year in the United States, multiplying that number by how many things that must be coded for every visit, suddenly there are billions of codes that need to be accurately recorded, not only for reimbursement but to offer insight into how effective treatment is at a medical facility and research and analysis.
Since medical codes change all the time, coders face a challenging job that requires an understanding of medical terminology and a willingness to always learn something new. But it’s a rewarding career for those who consider themselves detail-oriented people.
Looking for a medical coding team you can trust? Contact MBA Medical, today!