For anyone looking to pursue a career in the medical field, medical coding can be a fulfilling, challenging, and lucrative path to go down. 

But while you might have heard of the phrase, you might be wondering – what is medical coding? You might also wonder if it’s the same as medical billing. 

That’s why I put together this post that details what medical coding is, where it happens, and what makes it different from things like medical billing.

That way, if you are interested in pursuing medical coding, you’ll have a better sense of exactly what you’d be getting into, and if it might be the right career for you.

Sound interesting? Keep reading to find out more!

What Does a Medical Coder Do?

In a way, medical coders are translators. But instead of translating from one speaking language to another, they translate medical information into alphanumeric codes.

This information includes medical services, diagnoses, equipment, and procedures. The medical coder will find the information on a variety of medical record documentation that they then need to translate.

These sources include lab results, radiologic results, physicians’ notes, and translate them into diagnoses and procedure codes. 

This is a crucial step in the medical billing process.  It takes more abstract information from doctors and translates them into specific alphanumeric codes.

Those codes then are submitted to insurance providers to assess the payment process.

What Type of Codes Are Used?

Medical coders are responsible for translating patient data into codes in a variety of categories. There are codes specifically for a patient’s diagnosis, as well as the codes outlining the treatments, supplies or services needed.

There are also codes for the treatments received on the day of their visit, as well as any condition or circumstance that changed those treatments. 

So it’s vital that medical coders have a deep understanding of physiology and human anatomy. They also need to know the ins and outs of the regulatory guidelines of the billing and coding process. 

Why Is Medical Coding So Important?

Having a universally understood coding system is vital for the continuity and understanding of patient records. It’s also important to help payment and healthcare provider reimbursements. 

In order to correctly charge a patient or their healthcare provider, you need to have a clear assessment of their treatment and services. 

So medical coders provide that essential link in translating what was done for a patient during a visit to a standardized form. That form can then be quantified for billing purposes. 

It’s not only important for accurate billing though. Healthcare history is now digitized and shared for a patient throughout their life. So it’s also important that those records are precise and easy to understand. 

So medical coders are also helping each patient keep a tangible record of their own personal medical history.

The Challenges of Medical Coding

As you’re probably aware, there are thousands of injuries, diseases, and ailments out there. And there are equally as many types of treatments and medical services that doctors perform for patients. 

Add to that the fact that a large percentage of both categories have acronyms, specific subcategories and descriptors, and alternate names. So a medical coder has their work cut out for them in terms of learning a vast amount of information.

They must take all these variations and translate them to the common medical coding language.

That way providers and hospitals can send standardized information to insurance providers or other healthcare providers. They do this in accordance with the  Health Information Portability and Accountability Act, or HIPAA.

A Day as A Medical Coder

The beginning of a medical coder’s day is usually spent going over patient notes from the previous day and translating any un-coded data into the proper codes. 

They will use their expertise and training to figure out all of the procedures, treatments, and services provided for each of the previous day’s patients. They also include information like dates, names of doctors, and other info. 

Then they use codebooks to translate all this information into the standardized medical codes. Sometimes this process is straightforward and moves along quickly. 

Other times there will be gray areas in terms of how to code specific elements of a patient’s visit.

If they are having trouble assigned medical codes to it, they’ll often reach out to their coworkers, their peers in the medical coding community and online forums for advice.

Once they have entered all the relevant data and put it accurately into medical code, they’ll move to the patients who are currently coming into the office that day. 

What’s the Difference Between Medical Coding and Medical Billing?

These two fields have overlaps but are actually separate from one another. They both involve the translation of health care services to medical claims.

But a medical biller focuses primarily on the follow-up process to make sure that healthcare providers are paid by insurance companies and patients. 

They also focus on reviewing all of the documentation regarding billing. This means looking for any inaccuracies and omitted information. They’ll work to get referrals and pre-authorizations for patients.

They’ll also keep all the relevant spreadsheets up to date, and complete collection reports for the healthcare provider’s books. 

Depending on the situation, some people end up doing both and are relied upon for billing and coding. But just as often, the two jobs are kept separate and require separate, specific training.

What is Medical Coding?

Hopefully, if you had the question, “what is medical coding?” then you now have your answer. 

And now hopefully you also know the difference between medical coding and medical billing. 

Medical coding is a field that requires hard work, diligence, and attention to detail. So if you want to be involved in the medical community and have those traits, then perhaps medical coding is right for you.

If you’d like to know more about choosing the right medical billing software, check out this blog post.