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What is Medical Coding?

what is medical codingMedical coders hold a key role in the success of many types of health care companies. Whether its a hospital, physician’s office, or other managed health care setting, coders are relied on everyday for the success of the company.  The primary role of a medical coder is to ensure that these organizations are properly reimbursed for patient care from insurance companies.

With the almighty dollar as the driving force, everyone wants to get the most for their money.  Because of the great financial weight of this career,  medical coders have a tremendous responsibility to correctly transfer information from medical charts into the proper, accurate form for billing.

Medical coders are basically translators.  They translate descriptions of medical diagnoses and procedures, which might include doctor’s notes, laboratory results, radiologic results, and more and assigns each one a billing code.  These codes are predetermined and placed into manuals for coders to reference as they work.   Codes assigned to a patient are used to justify treatments–and if a chart is coded incorrectly, its easy for an insurance company to refuse to pay for lab work, diagnostic procedures or even surgery if they don’t have proper codes to prove its necessity.   There are several different coding systems, including CPT®, HCPCS and ICD-9-CM, but if  it all sounds like alphabet soup, don’t worry. You’ll learn more about each system when you are trained.

Changing technology is moving the role of a medical coder to a position that requires a lot of time spent in front of a computer.  Because of this, coders must be well trained in how to safely manage a patient’s personal records and protect sensitive information.

A career as a medical coder has a stable future ahead.  In fact, the US Labor Department says that the field will grow 18% over the next five years.


Training and Certifications

Medical coders have to learn the specialized medical codes that make medical information readable by all health systems.  In essence, it’s like a special language.

Medical coders do not need to have a college degree, but some programs offer an associate degree program.  Medical coders usually take classes in:

  • Medical Terminology
  • Anatomy
  • Physiology
  • Data Coding and Abstraction
  • Database Management

Once the coursework is completed, students may choose to take the Certified Coding Associate (CCA) exam.  While not all medical coders are certified, most employers prefer to hire medical coders who are certified.  Exams are offered by either the American Health Information Management Association (AHIMA) or the American Academy of Professional Coders (AAPC).  Without a certification, it can be difficult to get started as a coder.  Unless you are lucky enough to find a small private physician’s office who is willing to train you, it’s just not the most effective way to go.


Skills Needed

Medical coders must be detail-oriented, careful, and attentive.  If information is entered incorrectly or not at all, there could be serious complications–and it usually comes as a serious financial blow to the hospital, organization or even the patient themselves.  Simply overlooking a sentence in a physician’s note which justifies a procedure, could cause insurance companies to refuse reimbursement–and that’s a big problem.  Overlooking a detail could cost tens of thousands of dollars for someone.

Advantages

Because medical coders have no direct hands-on patient care, they can work from home or in an office, and can often choose whether they wish to work full or part-time.  “I love what I do,” explains Michelle Duram, a medical coder in Indianapolis.  “I worked in a doctor’s office for a few years until I had some experience, and now I work from home.  I like the idea of helping people, but I would rather work alone without a lot of other distractions, so this is the perfect job for me.” Not all coders can work from home, and virtually everyone has to start out on-site. So don’t expect to set up that home office for at least a year or two.


Specialties

Not all medical coders work in insurance and billing.  Medical information can also be used for research purposes and education.  For example, some medical coders specialize in working for cancer registries maintaining local or national tumor databases.  In fact, you can take specialty exams in numerous areas, including cardiology, oncology, dermatology, family practice, and more.

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For more information on the field of medical coding, contact the Professional Association of Healthcare Coding Specialists (http://www.pahcs.org).

About the Author

Rachel Ballard, RNC, BSN is a registered nurse with almost a decade of clinical experience in both acute care and public health settings.

Read Rachel's full bio here...

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