Medical Billing and Coding

What is Medical Billing and Coding?

Medical billing and coding professionals collect and analyze medical treatments, procedures and tests in order to transcribe them into standardized codes. The codes are later sent to bill government and commercial payers for reimbursement.

What do medical coders do?

Medical coders are responsible for reviewing clinical documentation and extracting data that can be turned into medical codes. 

This is done with classification systems such as:

CPT - Current Procedural Terminology ( or CPT) refers to a set of medical codes used to describe the care and services performed by healthcare professionals.

These consist of: 

• CPT Category I—the largest body of codes that hold codes commonly used by healthcare providers to report their services and procedures
• CPT Category II—additional codes used for performance management
• CPT Category III—temporary codes used to describe emerging and experimental procedures

Other classification systems used are ICD-10-CM and HCPCS Level II systems.

Who can use medical coding? 

Medical coding is also called medical classification and refers to the process of translating medical reports into codes used within the healthcare industry.  Anyone using medical codes to summarize medical services and reports can have use of medical coding training. 

• physicians
• allied health professionals
• hospitals
• patient facilities
• medical laboratories.

What do medical billers do?

Medical billing submits medical records to insurance companies in order to receive payment for the services offered by a healthcare professional.  Similar to the medical coder, medical biller have to understand and read medical records and use coding systems such as CPT.

Medical biller's work depends on their place of work but they are usually responsible for:

• gathering patient information
• verifying the patient's health plan coverage,
• collecting copays
• clecking that procedure, diagnosis, and modifier codes are correct before transmitting claims to healthcare insurance and posting payment.