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The phrase "medical billing and coding" refers to a system in which medical office personnel enter information into patient records to ensure proper billing.

It's a way to consistently treat, document and submit for payment a range of different medical issues or conditions. Accuracy is vital to ensure that the patient is treated and billed properly.

Correct medical billing and coding is essential to:

• Prevent overbilling
• Prevent underbilling
• Ensure that patients receive appropriate care

The field requires skill and accuracy as patient records are both sensitive and vital for treatment and billing.

To pursue this career, students need to understand procedures and rules, relevant federal laws and regulations such as HIPAA and, of course, those unique codes.��

Healthcare providers use specific codes and terminology that may be unfamiliar to most patients. Codes are kind of like abbreviations — they serve as easier-to-remember terms. For example, everyone has heard the abbreviation "GPS," but not everyone knows it stands for "Global Positioning System."

Medical codes are kind of like that, and they typically fall into one of two categories:

• Diagnosis
• Treatment

Diagnostic codes are related to specific issues or symptoms the patient reports to medical personnel at intake and/or during an examination. These intake points can be with doctors, nurses or admitting or clinical staff.

Diagnostic codes include a range of possibilities, from the common cold to rare, complex cancers.

After diagnosis, medical providers will often begin treatment. "Medical diagnosis is focused on the issue the patient has," explains Steiness.��"Treatment codes are focused on the treatment(s) that the providers used to assist the patient.��One diagnosis may lead to multiple treatments."

As that treatment evolves, the diagnostic codes in the accompanying patient file will be updated or changed depending on the health issue, corresponding treatment or even discharge.

Codes are not only for the internal medical staff to read and follow but also for the healthcare industry at large. Medical coding is a vital language used to communicate between healthcare providers (or medical offices) and a patient’s insurance company.

These codes speed things up for everyone who is reviewing paperwork and authorizing procedures or payments. Medical codes also help reduce mistakes in payment processing, billing and even diagnosis and treatment.

Coders who work in the medical billing and coding field often come across various code types, each with its own unique abbreviation.

Here’s an explanation of what each type of coding term stands for:

• “CPT codes” stand for “Current Procedural Terminology.” What that means is procedural codes related to medical claims are usually generated to bill insurance companies. For example, the doctor performed a routine physical and uses the code to get reimbursed by an insurer.

• “ICD-10” stands for “International Classification of Diseases.” This code refers to diagnoses used in all healthcare settings. For example, a person diagnosed with a wrist fracture might be coded as an “S62.” The “S” refers to an injury caused by something external to the patient, while the “62” refers to a fracture of the wrist bone.

• “Bundling” stands for two or more diagnoses. This code helps healthcare providers who are caring for a patient with two diagnoses or other health-related issues at the same time, such as an injury to two areas of the body or an illness that has spread. For example, if a patient receiving a bone X-ray is then treated for a broken bone, the X-ray and treatment services would likely be bundled under one code to streamline everything.

• “COB” stands for “Coordination of benefits.” This refers to when two insurance companies work together to pay claims for a patient. This applies to patients with multiple health plans or patients with Medicare and a private health plan. For example, spouses may have separate healthcare coverage through their respective employers and have a baby on the way. There may be a need to coordinate coverage for that.

Bundling helps healthcare providers who are caring for a patient with multiple diagnoses or other health-related issues at the same time. This might be an injury to two areas of the body or an illness that has spread and is affecting multiple organs. It keeps everything simple, contained and related, and reduces the number of codes other personnel must notice and pay attention to. (And that, of course, potentially reduces the likelihood of medical errors.)

COBs can also be complex. They are there to help determine which insurance plan has the primary payment responsibility and the extent to which the other plans will contribute, .

A medical biller or coder will typically have the crucial responsibility of going through a patient’s medical file after an appointment and determining, based on the services provided to the patient (consultation, tests, treatments, etc.), which of those services to bill an insurance company and/or the patient and which universally accepted "codes" to use to notify those companies to explain what work was done and needs to be paid for.

Without a good medical coder, a hospital, doctor’s office or other medical institution may end up overbilling an insurance company or underbilling and not getting the medical provider properly reimbursed and thus lose money.

While medical coders may fall under a company’s "billing" department, they are not necessarily medical billers. That job is for the person who processes the insurance claims and follows up on them. They do not determine what codes are used in the insurance billing.

Nonetheless, a medical coder may also take on the responsibilities of a medical biller if that person is trained in both roles.

A medical coder might have any of the following job titles:

• Medical Billing Specialist
• Medical Billing Coder
• Coder, Billing Department
• Medical Records Clerk/Technician
• Health Information Technician
• Coding Specialist

A medical coder has similar work responsibilities wherever they work. Medical coders can also choose to get certification in specific concentrations. There aresome standard certifications, along with several medical coder certification organizations.

Like any good team, the terms "medical billing and coding" are rarely seen apart. But the fact is these two fields are not the same thing.

Medical coding is the first step. During this process, a skilled medical coder will take a diagnosis, treatment or prescription and turn it into the right numeric or alphanumeric code. Each code is subject to its own set of guidelines; even the order in which codes appear can impact treatment and billing.

Medical billing, meanwhile, picks up where coding leaves off. Medical billers create a claim based on the medical codes and then assess what is due from the patient after insurance pays its portion. In essence, they act as the point of contact for the insurance company, the patient and, in some cases, the collections agencies.

Those working in medical billing and coding can sometimes be referred to as simply "medical coders". There are many coding specializations, however, including certified professional coders and coding for outpatient care, inpatient care and risk adjustment.

There are several different career paths for those interested in this field. Specialists can work for hospitals and clinical practices, health insurance companies and government agencies.

According to the U.S. Bureau of Labor Statistics, as of May 2024, medical records and health information technicians earned .��

Employment of medical records and health information technicians is projected to . About 14,200 openings for medical records specialists are projected each year, on average, over the decade.��

Salary ranges are not specific to students or graduates of ������Ƶ. Actual outcomes vary based on multiple factors, including prior work experience, geographic location and other factors specific to the individual. ������Ƶ does not guarantee employment, salary level or career advancement. BLS data is geographically based. Information for a specific state/city can be researched on the BLS website.

BLS Occupational Employment Projections, 2024-2034 is published by the U.S. Bureau of Labor Statistics. This data reflects BLS’ projections of national (not local) conditions. These data points are not specific to ������Ƶ students or graduates..

According to the BLS, becoming a medical biller or coder requires a high school diploma and often certification. Some employers may require additional education, such as an associate degree, as well.

Typically, this process can take anywhere from a few months to up to a year-and-a-half, depending on how much time a student takes between courses. Time varies if a student pursues certification or decides on a broader, more general bachelor’s or associate degree in healthcare.

A big reason to get certified as a medical biller or coder is because it brings a proven skill set to potential employers.

Several types of medical coding certifications are available and obtainable with a few months of study (see below.) Indeed.com suggests that people interested in breaking into the medical coding field consider taking a certification exam after completing a specialized course and/or on-the-job experience.

Certifications can be pursued through the AAPC, AHIMA or other professional organizations. Students can also pursue a specialization like those noted earlier in outpatient coding, risk adjustment coding and inpatient coding.

Certifications are facilitated by professional organizations and include:

• Certified Coding Specialist (CCS)
• Certified Medical Coder (CMC) from the Practice Management Institute (PMI)
• Certified Professional Biller (CPB)
• Certified Coding Associate (CCA) from the American Health Information Management Association (AHIMA)
• Certified Billing and Coding Specialist (CBCS) from the National Healthcareer Association
• Certified Outpatient Coding (COC)
• Certified Professional Coder (CPC)

Make sure to review the requirements for certification closely, as some require associate degrees, experience in medical billing or coding and/or a certificate (not a certification) of course completion from an accredited university.

One way to learn the foundations of becoming a medical biller or medical coder is to take a self-directed online course in the fundamentals This type of course is meant for people to learn the basics related to medical coding. Often, students can study at their own pace.

Courses can be helpful for both established professionals and new learners. For professionals, medical billing and coding courses can be useful to help processes within a practice to operate at full potential. Professionals may also take courses to better understand the revenue stream for a practice or healthcare setting.

New learners can take courses to learn how coding is used in the industry, such as to bill insurance companies, and to learn how payers are billed and providers are paid.

If you're ready to look at medical billing and coding education, ������Ƶ has several options in professional development areas:

• Medical Coding Fundamentals
• Medical Records Certificate Program
• Fundamentals of Electronic Health Records Course