Medical coding is the transformation of healthcare diagnosis, procedures, medical services, and equipment into universal medical alphanumeric codes. The diagnoses and procedure codes are taken from medical record documentation, such as transcription of physician’s notes, laboratory and radiologic results, etc. Medical coding professionals help ensure the codes are applied correctly during the medical billing process, which includes abstracting the information from documentation, assigning the appropriate codes, and creating a claim to be paid by insurance carriers.
What Does a Medical Coder Do?
Medical Coders work in a variety of settings and their individual workday may differ based on the size of a facility, type of physician, type of specialty, etc. The following example outlines what a typical day in the life of a Medical Coder may look like.
After settling into the office and grabbing a cup of coffee, a medical coder usually begins the workday by reviewing the previous day’s batch of patient notes for evaluation and coding. The type of records and notes depends on the clinical setting (outpatient or facility) and may require a certain degree of specialization (Larger facilities may have individuals who focus on medical specialties while coders who work in smaller, or more general offices, may have a broad range of patients and medical conditions.).
Selecting the top patient note or billing sheet on the stack, the coder begins reviewing the documentation to understand the patient’s diagnoses assigned and procedures performed during their visit. Coders also abstract other key information from the documentation, including physician names, dates of procedures, and other information.
Coders rely on ICD-10 and CPT code books to begin translating the physician’s notes into useful medical codes. An example of basic procedure documentation and subsequently assigned codes can be seen below.
Example:
Date of Procedure: 6/5/20xx
Patient Name: John Smith
DOB: 10/13/19xx
Diagnosis: Pigmented mole
Procedure Performed: Cryoablation of pigmented mole
Indications: Mr. Smith is a 50-year-old male who comes into the office today to have a pigmented mole removed. The mole is located on the patient’s back right at the level of his waistband, which is causing discomfort and irritation. He is requesting removal of the offending mole. The plan today is to remove the mole via cryoablation.
Procedure: The area around the mole was prepped with a Betadine solution and injected with 1 cc of lidocaine mixed with epinephrine. We proceeded to apply liquid nitrogen to the mole to freeze it down to the cutaneous level for the adequate destruction of the lesion. I placed a dressing on the area to avoid irritation by the patient’s clothing. The patient tolerated the procedure well with no complications, with the plan to return to the office in a week for follow-up.
Based on the previous note the medical coder would assign the following codes:
CPT code: 17110 – Destruction (e.g. laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), of benign lesions other than skin tags or cutaneous vascular proliferative lesions; up to 14 lesions.
ICD-9-CM code: D22.5 Melanocytic nevi of the trunk.
Many cases are simple to code. Individual medical coders develop a detailed understanding of the procedures and commonality of their specific clinic or facility. Coders occasionally encounter a difficult note requiring in-depth research, taking more time to code correctly. Even among the more commonly used codes are significant gray areas open for examination among coders. With very complex or unusual cases, coding guidelines may be confusing to interpret. Experienced coders will rely on their network of peers and professionals to discuss nuances in online forums, networking with specialists they have met at national conferences, or consult with co-workers to help understand the issue and determine the proper codes. Ongoing training and current coding-related periodicals also provide important opportunities to advance understanding and professionalism.
Finally, the coder completes the chart and begins the next patient record. This cycle of reading, note taking, assigning codes, and computer entry repeat with each chart. Most coders will spend the majority of their day sitting at the computer reading notes and using their computer to enter data into a billing system or search for information to clarify the documentation in the notes.
Professional coders largely work independently. However, interaction with coding staff, medical billers, physicians, and ancillary office staff is essential. Medical coders are usually placed on tight production schedules and expected to complete a determined number of notes each day or to keep their lag days at a specified timeframe. Lag days are the number of days it takes for the notes to be documented to the actual claims submission date. The prime date is usually between two to five days.
Depending on the clinical setting, internal or external auditors will periodically perform audits of the coding and documentation for accuracy and completeness. The results of these coding audits are maintained by the compliance department or the department supervisor and are a significant part of job evaluations.
At the end of the day coders return unprocessed work, check productivity either by a manual count or by running a system report and clean their work area. Depending on the clinical setting, medical coders may share a workspace with other coders assigned to opposing shifts where coding may continue around the clock. Some coders work alone from their home office.
Is Medical Coding the same as Medical Billing?
The main task of a medical coder is to review clinical statements and assign standard codes using CPT®, ICD-10-CM, and HCPCS Level II classification systems. Medical billers, on the other hand, process and follow up on claims sent to health insurance companies for reimbursement of services rendered by a healthcare provider. The medical coder and medical biller may be the same person or may work with each other to ensure invoices are paid properly. To help promote a smooth coding and billing process, the coder checks 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. Both works together to avoid insurance payment denials.
The medical coder and biller process a variety of physician services and claims on a daily basis. Medical codes must tell the whole story of the patient’s encounter with the physician and must be as specific as possible in regard to capturing reimbursement for rendered services.
Education and training is key to becoming a skilled and successful medical coder. The first step coders must take is to have a thorough knowledge of anatomy and medical terminology. It’s also important to become familiar with the codebook resources CPT®, HCPCS Level II, and ICD-10-CM and their coding systems. It’s also vital to know the coding systems’ corresponding guidelines and what codes are accepted by which insurance plans, which government and payer regulations to follow, and how to be compliant while coding.
Besides assigning CPT®, ICD-10-CM, and HCPCS Level II codes correctly to claims, coders may also audit and re-file appeals of denied claims. They may step into the role of educator to providers and recommend the appropriate codes that follow federal mandates and compliance. When coders are auditors as well, they will require providers to use specific coding and billing standards through chart audits. They may also speak on behalf of the provider and patient on coverage and medical necessity issues. The standard medical coding professional obtains the Certified Professional Coder (CPC®) credential. The good news is coding-related jobs are expanding due to the growing landscape of the business side of healthcare. For example, Certified Professional Medical Auditor (CPMA®), Certified Professional Compliance Officer (CPCO™), and Certified Physician Practice Manager (CPPM®), etc., are areas that coders can branch into.
What role do medical coders play in the healthcare system?
Think back to the last time you visited a doctor. You were probably greeted by a medical administrator, got your vitals taken by a nurse and then examined by a doctor. But there’s a lot more happening behind the scenes that patients never see.
After a medical provider examines or treats a patient, the insurance company needs to understand what was done in order to process the bill. The common language is too inexact to give the insurance company the accurate details it needs, so a set of specific codes has been established to define medical procedures.
Medical coding is essentially a specialized language for the medical and insurance industries. Medical coders are the professionals who translate the notes from the doctors and other medical professionals into a uniform set of codes that is given to the insurance provider.
Where do medical coders work?
You may assume you know the answer to this question — hospitals, of course! But there are several other settings a medical coder might work. The simple answer is that these professionals are employed anywhere that provides medical services. This includes hospitals, clinics, urgent care facilities, nursing homes, treatment centers and more.
Some insurance agencies also employ medical coders to handle patient claims from the other side of the table, verifying the accuracy of incoming claims. Speaking of accuracy, some medical coders are hired by law firms to help identify billing fraud.
What are some qualities that successful medical coders share?
There is no “typical” prototype when it comes to medical coders. You’ll find men and women, young and old, single and married. But good medical coders do share some common characteristics that help them on the job. One critical trait is a high ethical standard because the patient data they work with is highly confidential.
Medical coders must also have a keen eye for detail, as one miniscule mistake in a code could lead to much larger issues. They also must be able to remain focused because their work is rather repetitive, yet extremely important.
What are some important skills medical coders need?
There are a handful of technical skills medical coders need to succeed in the field, but transferable skills are important as well. We used real-time job analysis software to examine more than 125,000 medical coding job postings from the past year.1 The data revealed the most important skills employers are seeking.
Here’s what we found:
If you can relate to a few of the skills on the right, you may be a natural fit for a career as a medical coder. Don’t be intimidated by the list on the left — those are precisely the skills you’ll acquire from formal training.
How do you become a medical coder?
Becoming a medical coder requires specialized training and certification. It’s not a job just anyone can perform. But that’s what makes medical coders valued professionals in the world of healthcare.
Although training is essential, the time it will take is significantly less than other healthcare professions. Many medical coding programs can be completed online in as few as nine months.2 This fast and flexible option means aspiring medical coders can fit this training into their busy schedules. It’s an ideal pathway for working adults with financial and family obligations.
Upon completing a medical coding program, the next step is to take the CCA (Certified Coding Associate) or CCS (Certified Coding Specialist) exams offered by the American Health Information Management Association (AHIMA). This step is not always required but is typically favored by employers.
What is Medical Coding?
Medical coding is the transformation of healthcare diagnosis, procedures, medical services, and equipment into universal medical alphanumeric codes. The diagnoses and procedure codes are taken from medical record documentation, such as transcription of physician’s notes, laboratory and radiologic results, etc. Medical coding professionals help ensure the codes are applied correctly during the medical billing process, which includes abstracting the information from documentation, assigning the appropriate codes, and creating a claim to be paid by insurance carriers.
What Does a Medical Coder Do?
Medical Coders work in a variety of settings and their individual workday may differ based on the size of a facility, type of physician, type of specialty, etc. The following example outlines what a typical day in the life of a Medical Coder may look like.
After settling into the office and grabbing a cup of coffee, a medical coder usually begins the workday by reviewing the previous day’s batch of patient notes for evaluation and coding. The type of records and notes depends on the clinical setting (outpatient or facility) and may require a certain degree of specialization (Larger facilities may have individuals who focus on medical specialties while coders who work in smaller, or more general offices, may have a broad range of patients and medical conditions.).
Selecting the top patient note or billing sheet on the stack, the coder begins reviewing the documentation to understand the patient’s diagnoses assigned and procedures performed during their visit. Coders also abstract other key information from the documentation, including physician names, dates of procedures, and other information.
Coders rely on ICD-10 and CPT code books to begin translating the physician’s notes into useful medical codes. An example of basic procedure documentation and subsequently assigned codes can be seen below.
Example:
Date of Procedure: 6/5/20xx
Patient Name: John Smith
DOB: 10/13/19xx
Diagnosis: Pigmented mole
Procedure Performed: Cryoablation of pigmented mole
Indications: Mr. Smith is a 50-year-old male who comes into the office today to have a pigmented mole removed. The mole is located on the patient’s back right at the level of his waistband, which is causing discomfort and irritation. He is requesting removal of the offending mole. The plan today is to remove the mole via cryoablation.
Procedure: The area around the mole was prepped with a Betadine solution and injected with 1 cc of lidocaine mixed with epinephrine. We proceeded to apply liquid nitrogen to the mole to freeze it down to the cutaneous level for the adequate destruction of the lesion. I placed a dressing on the area to avoid irritation by the patient’s clothing. The patient tolerated the procedure well with no complications, with the plan to return to the office in a week for follow-up.
Based on the previous note the medical coder would assign the following codes:
CPT code: 17110 – Destruction (e.g. laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), of benign lesions other than skin tags or cutaneous vascular proliferative lesions; up to 14 lesions.
ICD-9-CM code: D22.5 Melanocytic nevi of the trunk.
Many cases are simple to code. Individual medical coders develop a detailed understanding of the procedures and commonality of their specific clinic or facility. Coders occasionally encounter a difficult note requiring in-depth research, taking more time to code correctly. Even among the more commonly used codes are significant gray areas open for examination among coders. With very complex or unusual cases, coding guidelines may be confusing to interpret. Experienced coders will rely on their network of peers and professionals to discuss nuances in online forums, networking with specialists they have met at national conferences, or consult with co-workers to help understand the issue and determine the proper codes. Ongoing training and current coding-related periodicals also provide important opportunities to advance understanding and professionalism.
Finally, the coder completes the chart and begins the next patient record. This cycle of reading, note taking, assigning codes, and computer entry repeat with each chart. Most coders will spend the majority of their day sitting at the computer reading notes and using their computer to enter data into a billing system or search for information to clarify the documentation in the notes.
Professional coders largely work independently. However, interaction with coding staff, medical billers, physicians, and ancillary office staff is essential. Medical coders are usually placed on tight production schedules and expected to complete a determined number of notes each day or to keep their lag days at a specified timeframe. Lag days are the number of days it takes for the notes to be documented to the actual claims submission date. The prime date is usually between two to five days.
Depending on the clinical setting, internal or external auditors will periodically perform audits of the coding and documentation for accuracy and completeness. The results of these coding audits are maintained by the compliance department or the department supervisor and are a significant part of job evaluations.
At the end of the day coders return unprocessed work, check productivity either by a manual count or by running a system report and clean their work area. Depending on the clinical setting, medical coders may share a workspace with other coders assigned to opposing shifts where coding may continue around the clock. Some coders work alone from their home office.
Is Medical Coding the same as Medical Billing?
The medical coder and biller process a variety of physician services and claims on a daily basis. Medical codes must tell the whole story of the patient’s encounter with the physician and must be as specific as possible in regard to capturing reimbursement for rendered services.
Education and training is key to becoming a skilled and successful medical coder. The first step coders must take is to have a thorough knowledge of anatomy and medical terminology. It’s also important to become familiar with the codebook resources CPT®, HCPCS Level II, and ICD-10-CM and their coding systems. It’s also vital to know the coding systems’ corresponding guidelines and what codes are accepted by which insurance plans, which government and payer regulations to follow, and how to be compliant while coding.
Besides assigning CPT®, ICD-10-CM, and HCPCS Level II codes correctly to claims, coders may also audit and re-file appeals of denied claims. They may step into the role of educator to providers and recommend the appropriate codes that follow federal mandates and compliance. When coders are auditors as well, they will require providers to use specific coding and billing standards through chart audits. They may also speak on behalf of the provider and patient on coverage and medical necessity issues. The standard medical coding professional obtains the Certified Professional Coder (CPC®) credential. The good news is coding-related jobs are expanding due to the growing landscape of the business side of healthcare. For example, Certified Professional Medical Auditor (CPMA®), Certified Professional Compliance Officer (CPCO™), and Certified Physician Practice Manager (CPPM®), etc., are areas that coders can branch into.
What role do medical coders play in the healthcare system?
Think back to the last time you visited a doctor. You were probably greeted by a medical administrator, got your vitals taken by a nurse and then examined by a doctor. But there’s a lot more happening behind the scenes that patients never see.
After a medical provider examines or treats a patient, the insurance company needs to understand what was done in order to process the bill. The common language is too inexact to give the insurance company the accurate details it needs, so a set of specific codes has been established to define medical procedures.
Medical coding is essentially a specialized language for the medical and insurance industries. Medical coders are the professionals who translate the notes from the doctors and other medical professionals into a uniform set of codes that is given to the insurance provider.
Where do medical coders work?
You may assume you know the answer to this question — hospitals, of course! But there are several other settings a medical coder might work. The simple answer is that these professionals are employed anywhere that provides medical services. This includes hospitals, clinics, urgent care facilities, nursing homes, treatment centers and more.
Some insurance agencies also employ medical coders to handle patient claims from the other side of the table, verifying the accuracy of incoming claims. Speaking of accuracy, some medical coders are hired by law firms to help identify billing fraud.
What are some qualities that successful medical coders share?
There is no “typical” prototype when it comes to medical coders. You’ll find men and women, young and old, single and married. But good medical coders do share some common characteristics that help them on the job. One critical trait is a high ethical standard because the patient data they work with is highly confidential.
Medical coders must also have a keen eye for detail, as one miniscule mistake in a code could lead to much larger issues. They also must be able to remain focused because their work is rather repetitive, yet extremely important.
What are some important skills medical coders need?
There are a handful of technical skills medical coders need to succeed in the field, but transferable skills are important as well. We used real-time job analysis software to examine more than 125,000 medical coding job postings from the past year.1 The data revealed the most important skills employers are seeking.
Here’s what we found:
If you can relate to a few of the skills on the right, you may be a natural fit for a career as a medical coder. Don’t be intimidated by the list on the left — those are precisely the skills you’ll acquire from formal training.
How do you become a medical coder?
Becoming a medical coder requires specialized training and certification. It’s not a job just anyone can perform. But that’s what makes medical coders valued professionals in the world of healthcare.
Although training is essential, the time it will take is significantly less than other healthcare professions. Many medical coding programs can be completed online in as few as nine months.2 This fast and flexible option means aspiring medical coders can fit this training into their busy schedules. It’s an ideal pathway for working adults with financial and family obligations.
Upon completing a medical coding program, the next step is to take the CCA (Certified Coding Associate) or CCS (Certified Coding Specialist) exams offered by the American Health Information Management Association (AHIMA). This step is not always required but is typically favored by employers.
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