Medical coding, sometimes referred to as medical classification, is a standardized process involving the assignment of alphanumeric and numeric codes to the medical diagnoses of patients and the procedures that were performed. Medical coders use lab results, medical records, or transcribed physician’s notes to determine the codes for various diagnoses and procedures.
Medical codes serve several purposes. In addition to being used on Medicaid and Medicare reimbursement forms, diagnostic request forms, and insurance claim forms, medical codes are also very useful for statistical and research purposes in order to track heart disease, flu, diabetes, and other major diseases and illnesses.
Types of Medical Codes
Medical coders use CPT codes, or Current Procedural Terminology codes, to code virtually everything from spinal surgery to simple office visits. ICD codes, or International Classification of Disease codes, are also used to identify the reason for a patient’s visit and their diagnosis. Medical coders must be well-versed in both CPT and ICD codes as combinations of these codes are regularly used on insurance, Medicaid, and Medicare claims forms to inform the necessary agencies of a patient’s problems and the care that they received.
The Difference Between Medical Coding and Medical Billing
While medical billers may also serve the function of medical coders in some settings, billing and collection is their primary concern. Medical coders, on the other hand, are not primarily concerned with billing or money-related matters. Rather, their primary concern simply lies in the accurate reporting of patient diagnoses and the specific medical care they received.
In other words, the primary role of certified medical coders is to act as translators between doctors and medical billers. They review the medical records of patients, which are written by physicians, nurses, therapists, technicians, and other medical professionals, and compare it to the established standards of the Centers for Medicare and Medicaid Services, the American Medical Association, and commercial health insurance plans. Then, they distill the written information provided by healthcare providers into standardized codes.
Diagnoses and procedures are translated into codes found within the Healthcare Common Procedural Coding System, the Current Procedural Terminology, and the International Classification of Diseases. These codes are used by medical billers to submit claims for the reimbursement of medically necessary services at agreed-upon rates by insurance companies and any other third-party payers. Public health officials, researchers, internal auditors, and statisticians also use these codes to determine the health of the patient population. As such, medical coding has a multitude of ramifications that not only affect the financial health of healthcare providers and institutions, but also public policy in general.
Becoming a Medical Coder
While a great number of medical coding professionals have boosted their careers by earning undergraduate and graduate degrees in the field, neither is a requirement for individuals seeking a lucrative career in medical coding. A bachelor’s or master’s degree may not be a requirement, but prospective medical coders must possess a solid understanding of medical terminology, physiology, and human anatomy. Thus, it is highly recommended for individuals serious about a career in this rewarding field to complete a course of study that focuses on medical coding, such as an Associate’s degree program.
Those interested in a career in medical coding should take courses to prepare for and pass the CPC exam in order to gain the credential of a Certified Professional Coder. Certified Professional Coders, known within the industry as CPCs, are in extremely high demand as employers know they have the requisite skills needed to perform their job function with the utmost proficiency.
No ordinary person can pass the CPC exam and become certified without experience and accredited training, which can be obtained through public and private universities, community colleges, and online study programs. Many medical coding training programs require students to perform an externship and become a Certified Professional Coder Apprentice, or CPC-A, for one year.