Medical coding is the transformation of diagnoses, procedures, medical services, and healthcare equipment into universal medical alphanumeric codes. Diagnosis and procedure codes are taken from medical record documentation, such as transcripts of physician notes, laboratory and radiological results, etc. Medical coding professionals help ensure codes are applied correctly during the medical billing process, which includes extracting information from the documentation by assigning the appropriate codes and creating a claim for insurance companies to pay.
Medical coding occurs every time you see a health care provider. The health care provider reviews your complaint and medical history, makes an expert assessment of what is wrong and how to treat it, and documents your visit. That documentation isn’t just the patient’s ongoing record, it’s how the health care provider gets paid.
medical codes translate that documentation into standardized codes that tell payers the following:
- patient diagnosis
- medical necessity of treatment, services or supplies received by the patient
- treatments, services and supplies provided to the patient
- any unusual circumstances or medical conditions that have affected those treatments and services
Like a musician who performs written music and uses his instrument to produce what is intended, medical coding requires the ability to understand the anatomy, physiology, and details of services, and payer rules and regulations to have success.
medical coding is derived from public mortality bills published in london in the eighteenth century. it was through the correlation of these that doctors determined the cause of a cholera epidemic. it is even more vital now that the data collected through medical coding is being used to improve healthcare overall. the results are sent to payers for reimbursement, but the data derived from the codes is also used to determine utilization, manage risk, identify resource use, create actuarial tables, and support public health and actions.
The medical coder and biller process a variety of services and claims on a daily basis. Medical codes should tell the full story of the patient’s encounter with the doctor and should be as specific as possible in capturing reimbursement for services rendered. To better understand what a coding transaction looks like, read the article “what does a medical coder do?”
the primary task of a medical coder is to review clinical statements and assign standard codes using the cpt®, icd-10-cm, and hcpcs level ii classification systems. Medical billers, on the other hand, process and track claims submitted to health insurance companies for reimbursement for services provided by a health care provider. The medical coder and medical biller may be the same person or they may work together to ensure that bills are paid correctly. To help promote a smooth coding and billing process, the coder checks the patient’s medical record (i.e., transcript of doctor’s notes, lab tests ordered, imaging studies ordered, and other sources) to verify the work done. both work together to avoid insurance payment denials.
