Tuesday, November 13, 2012

Exploring Medical Coding and Billing

When you visit your doctor, your medical insurance provider will probably receive a bill for CPT
code “99211.” That code tells the insurer that you had an “office visit.” If you got an x-ray or had
blood taken, those services would also be represented by CPT codes on your bill.
There are over 9,000 CPT (Current Procedural Terminology) codes – one for every type of
health care service provided by health care practitioners or facilities. There are another 13,500
ICD-9 codes for medical diagnoses, plus more codes for medical supplies and for various health
care settings.

Medical coders spend their days sorting through patient charts to assign these codes and
ensure that the health care providers they work for are properly reimbursed for their services.
Coding accurately is not easy – the coder must carefully read the doctor’s and nurse’s notes to
determine exactly what services the patient received.

Like taxpayers who fail to declare all the deductions they’re entitled to, coders often fail to bill for
services performed. By some estimates, inaccurate or incomplete coding costs the average
doctor thousands of dollars a year in lost payments.

Because physicians and hospitals depend on accurate coding to receive proper reimbursement,
the role of the coder is becoming more valued. Coders once learned their work “on the job.”
Now you can train to become a Certified Professional Coder (CPC), a designation that
demonstrates to potential employers a certain level of coding skill and accuracy.

Working Conditions
Medical coders work in every type of health care facility, including doctor’s offices, surgery
centers, hospitals and health care systems. Some coders have their own freelance businesses,
working from home and billing for their services on an hourly basis.

Coding is extraordinarily detail-oriented work. The coder must carefully review the patient’s
chart to learn the diagnosis and itemize every service that was provided. If a service is
overlooked, the provider will not receive payment for it. If the coder chooses the wrong code, the
provider may have to return any excess payment or face legal charges of “overbilling.”

Codes change constantly, so coders must keep abreast of new rules and interpretations. A solid
understanding of medical terminology, including anatomy, is

Academic Requirements
There are no standardized educational requirements to become a medical coder. Many current
coders started their careers as medical assistants, learning how to code simply because their
employer needed someone to do it.

Concerns about billing accuracy, particularly for Medicare patients, has turned the spotlight on
the coding function. Doctors have been accused of overcharging Medicare because they
submitted bills with the wrong codes.

Becoming a Certified Professional Coder designation tells potential employers that you
understand coding rules and have demonstrated a high level of accuracy in translating patient
charts into correctly coded insurance bills.

Training in coding skills is available at many community colleges and through online learning
centers. Most training programs can be completed in less than 18-24 months. Search for
schools that provide training for this career.

To become a Certified Professional Coder (CPC), you must pass an examination administered
by the American Academy of Professional Coders. Coders with less than two years’ experience
receive a CPC-A (apprentice) designation until their experience is complete. Different
examinations test your knowledge of coding for physician offices, outpatient facilities, or payers.
Annual recertification through continuing education is required to maintain certified status.

Because coding is based on the nature of the medical services provided, certification is
becoming available for specific medical specialties, including evaluation and management,
general surgery, and obstetrics and gynecology.

Outlook & Salary Range
Coders earn an average of $30,000 to $40,000 per year. Coders with specialty credentials can
earn as much as $85,000 a year.

According to the American Association of Professional Coders (AAPC), certified coders earn an
average 17% higher salary than non-certified coders. Many employers now require certification
for newly hired coders.

Reprinted courtesy of ExploreHealthCareers.org, funded in part by the Robert Wood Johnson Foundation of Princeton, NJ, and
administered by the American Dental Education Association, 1400 K Street, NW, Suite 1100, Washington, DC 20005. www.adea.org, 202-

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