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What is Medical Coding?

Medical coding, also referred to as insurance coding, is the assigning of diagnoses and procedure codes for medical encounters in physician's offices or hospitals for submission to insurance companies for reimbursement. A medical coder is the person who works in a medical provider's office, hospital, or billing office and reviews and assigns the proper medical codes to diagnoses and procedures. The medical coder processes claims to insurance companies for reimbursement of services provided to patients. It is a critical job in insuring that appropriate payment is received to reimburse providers for care.

what is medical coding

What is Medical Coding?

Each time a patient presents to a provider for services a code is attached to the procedure or diagnosis. Each medical visit has a CPT or encounter code, and each diagnosis has an ICD code. These are the codes that insurance companies use to reimburse medical providers for services. They help track reimbursements to physicians, hospital, and ancillary providers to prevent fraudulent claims or payment errors.

Medical coders are important to medical offices since they handle the billing to insurance companies, Medicare, and Medicaid. The accuracy of the billing will result in quicker reimbursement, and medical providers depend on reimbursement to keep their offices operating efficiently. Medical coders must receive the appropriate training to be proficient in their jobs.

Medical Coding Training

When reviewing what is medical coding, the first thing to look at is the training required to get ready for a career in medical coding. An individual must have a high school diploma in order to attend an accredited school for training in medical coding. Many programs offer an associate's degree in medical coding. Classes in medical coding are generally offered at Community Colleges or free-standing schools. There are several post-secondary education programs that offer medical coding certification.

Coursework in medical coding will include medical terminology, anatomy and physiology, health data requirement and standards, coding systems, data analysis, healthcare reimbursement methods, medical diagnosis codes, types of insurance plans, insurance regulations, CPT codes, HCPCS Level II and ICD-9-CM codes and guidelines.

Quality programs will also have classes on working in provider offices, medical ethics, coding software training, and effective job search techniques. Some schools will assist with employment placement. Make sure the school, whether bricks-and-mortar or online, is accredited by a national accreditation organization.

A Career in Medical Coding

The job in medical coding is important to the medical provider. Medical coders must have knowledge of disease processes as well as procedural techniques so that they can accurately apply the correct codes with billing. A knowledgeable medical coder is an integral part of the medical office team. Medical coders work in both inpatient and outpatient settings, as well as for third-party payers and for some medical coding software companies. There is currently a shortage of certified medical coders in healthcare facilities.

Payscale Salary Calculation shows the median hourly rate for medical coders as $15.00 per hour. This equates to approximately $30,000 per year for a full-time medical coder. Salary will depend on the level of experience and region of the country.