An Introduction to Billing & Coding

Medical coding and billing serve as two separate, but interrelated, business functions within the health care industry. Medical coding assigns codes to patient diagnoses and procedures. The codes then become part of the billing function, where they are used on claim forms to bill payers. In some environments, the same person performs both the medical coding and billing functions. In larger organizations, different health care professionals perform coding and billing.

Understanding Medical Coding

• Medical coding condenses lengthy patient information into short code formats. Medical coding professionals first review health information to determine the illnesses, diseases, treatments and surgeries for the patient. Numeric, and in some cases alphanumeric, codes are then assigned to the appropriate diagnoses and procedures. Used for a variety of reasons, medical codes provide information for reimbursement assignment, research, education, quality management and marketing.

Types of Codes

• Coding is made up of different coding classification systems. The most well-known systems include ICD-9-CM, or International Classification of Diseases, 9th Revision, Clinical Modification, and CPT, or Current Procedural Terminology. The ICD classification system covers medical diagnoses and procedures; whereas CPT codes primarily cover physician services and procedures. ICD-9-CM diagnosis codes are made up of three digits, a decimal and then one or two digits after the decimal (XXX.XX). ICD-9-CM coding procedures comprise two digits, a decimal, and then one or two digits (XX.XX). CPT codes comprise five digit codes, sometimes followed by two-digit modifier (XXXXX-XX).

Understanding Medical Billing

• Medical billing provides claim forms to insurances and other payers for the purpose of reimbursement of health care services. Medical codes and other information, including patient demographics, insurance information and physician information, are completed on a claim for each patient by medical billers. The billers then submit the claim forms, electronically or via the mail, to receive reimbursement for the provider. In some cases, medical billers work with payers to answer questions or clarify information, or with clinicians and coders for additional information to help appeal denial of claims.

Educational Requirements

• No standard education requirements exist for billing and coding. However, most medical coders and billers receive some type of training, generally through a non-degree diploma or certificate program online or at a local community college. Some programs teach coding only, billing only or a combination of the two. These programs last from a few months up to two years. Upon completion of the program, a student receives a diploma or certificate to mark completion. Some coders and billers further their careers by receiving a specialized certification, different than a certificate of completion. Certifications, including the Certified Coding Specialist or Certified Reimbursement Specialist, are offered through professional organizations, such as the American Health Information Management Association and the American Medical Billing Association.

Work Environments And Outlook

• Medical coders and billers work in a variety of health care settings, including hospitals, physician offices, home health care agencies, long term care services and even governmental organizations. Coders and billers generally work during normal business hours with computer software. According to a 2008 report by All Allied Health Schools, half of medical coders and billers made an annual salary between $35,000 and $45,000.