Medical Billing Coder

What does a Medical Billing Coder do? Learn what a medical billing coding career involves and what it takes to be a Certified Professional Coder.

The medical coder for many smaller practices may perform limited coding functions in addition to billing.

Good coding complements the billing process and insures the provider is getting fairly compensated for their work. Even if you want to stick strictly to medical billing, having a basic understanding of what the medical billing and coding specialist does is important.

Billing or Coding
I talk a lot about billing and coding together because they complement each other. There are people who know more about coding than me – and if I have a coding question I search them out. Having a good understanding of coding helps me make sure my doctors are getting paid fairly for the procedures they perform.

As an extra service for certain specialties I will occasionally contract a coder certified in that specialty to review superbills and EOB’s to insure we are coding correctly. This is a small expense that can pay handsomely for my provider and our business.

If you are a biller, the more you can learn about coding, the more valuable you are to a practice or billing company. Most small practices don’t have dedicated coders or billers – they multi-task. The office manager or doctors wife reluctantly handles the billing.

The medical coder assigns the proper ICD diagnosis and CPT treatment medical codes for services provided by a health care provider. This coded information is typically submitted either electronically or paper to the patients insurer.

The medical billing coder typically interprets the providers notes to accurately assign the proper codes. The insurance company then reimburses the physician for their services based on the coded

These diagnosis and treatment codes allow insurance companies to map the service provider’s services to assign payment. The codes assigned by the medical billing coder are also used by local and national governments and private healthcare organizations to gather statistical information and conduct research.

Claims that are not correctly coded will almost certainly not be paid by the insurance companies. When this happens the provider is left with:

  • Correcting the claim with the correct codes (and modifiers) and resubmitting.
  • Abandon the claim, charge the patient for the loss, and let the patient try to recover the charges.
  • Write off the claim and take a loss.

Importance of Proper Coding
Proper coding is so important to getting fairly reimbursed.

The medical billing coder really needs to know enough about coding to see when the CPT medical billing codes are not compatible with the ICD 9 codes.

For smaller practices many times the provider may do their own coding and the medical billing specialist acts more to identify out of date codes and correct them.

Most practices use a lot of the same CPT and ICD-9 codes so once you become familiar with the codes and medical billing modifiers, you’ve conquered the most difficult part. Most of these are listed on the practice superbill.

For family or internal medicine practices, you may see a wider variety of codes and modifiers than for specialty providers. My medical billing company serves many smaller practices that may need coding services, so we offer medical coding services to complement our billing services.

Many medical billers prefer to stay strictly with medical billing services and that’s great. But if you can become proficient in coding – even if you are not an expert – you’re much more valuable to a provider.

Medical Coding Certifications
Learn what Medical Coding Certifications are available and who administers the medical coding certificate