Understanding What Medical Billing And Coding Is

By Alley Benton
Updated January 2, 2017
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Understanding What Medical Billing And Coding IsMedical billing & coding is a system used to classify the diagnosis and treatment of an individual patient. They go above and beyond the well-known CPT and ICD-9 codes, however. This is because some codes relate specifically to Medicare, to dental treatment, to hospital revenues, to drugs, and so on. However, most people who look for codes generally look for CPT or ICD-10 codes.

Understanding What Medical Billing & Coding Is:

Medical billing & coding enables providers to get paid for the health services they provide. Some of the codes currently in use include:

- The ICD-10 codes, with some providers still using ICD-9

- CPT modifiers

- CPT codes

- CDT codes for dental work

- Medicare billing codes

- DRG medicare codes

- NDC drug codes

- Taxonomy codes

The Process of Medical Coding:

Very simply put, medical coding is a systematic process that turns diagnostics, health care procedures and services, and equipment used, into letters and numbers. These codes are added to all health care documentation by medical codes, which ensure that insurance carriers will be able to pay the right fees.

Medical coding and medical billing, however, are two different things. A medical coder will look through physician statements and then assign codes to them, using the various coding mechanisms. A medical biller, by contrast, will use this information to send it to the insurance companies and ask for payment. In many cases, people are both a medical biller and a medical coder, or if they are not, they tend to be very closely related because of the nature of their work.

Coders and billers generally deal with a wealth of claims and physician services every day. The code they assign tells the entire story of what happened when a patient visited a physician. This information is then used by insurance companies to make sure the right payments are being made.

To become a medical biller and/or coder, you must first learn about all the different codes that are out there. To understand these codes, however, you must have a sound foundation in medical terminology, as well as in anatomy. Additionally, you have to be aware of the different coding systems that are out there and which one you should use.

Besides assigning the codes for each claim, coders and billers may also re-file, audit, and appeal against decisions, and particularly denied claims. Often, they must educate others to ensure that the right codes are being used at all times. They do this through excellent communication skills, speaking on behalf of the patient, the organization, or even the insurance company. Specifically, they often work together with the insurance companies, ensuring that federal mandates are being adhered to. The role is incredibly varied and requires extensive knowledge of a range of different factors, coding mechanisms, national and international medical organizations, and so on. It is a highly skilled position that usually requires an associate's degree as a minimum, although many go on to complete a bachelor's degree in the field. This gives them a baseline of understanding of not just the codes, but also diagnostic and medical procedures.





* Disclaimer:
This site offers information designed for educational purposes only. You should not rely on any information on this site as a substitute for professional medical advice, diagnosis, treatment, or as a substitute for, professional counseling care, advice, diagnosis, or treatment. If you have any concerns or questions about your health, you should always consult with a physician or other health-care professional.