Category/ Medical Coding

What Does a Medical Coder Do? Starting Your Career as a Medical Coder!

What is Medical Coding? What Does a Medical Coder Do? Starting Your Career as a Medical Coder!

The job of a medical coder is to update the patient record with standardized information for use in billing and data management. Therefore, a code must be assigned whenever a physician, nurse, or other healthcare provider provides a service. As an example, suppose you are a medical coder reviewing the medical record undergoing an X-ray.

Once the technician finishes the X-ray, they will document it on the patient’s chart. An image examination will determine whether a fracture or a sprain caused the injury, and a doctor may prescribe treatment such as a sling or cast.

Your responsibility is to assign specific codes to the medical office to bill the insurance company correctly. Therefore, analyzing medical charts and giving codes are your primary responsibilities.

Codes can aid patients when they need their insurance company to pay their claims, and proper coding can assist providers by ensuring they get reimbursed by the insurer quickly.

It’s imperative to know that medical billing and medical coding involve two different types of work. Depending on the size of the facility, billing and coding may be performed by both people or separate specialists.


While dividing the work between two jobs, the medical coder will be primarily responsible for updating patients’ health records and verifying their coding accuracy; in the meantime, the medical biller addresses claim with insurance companies and follows up on them throughout the day. To understand Medical Billing and Coding Services, check out this article, “What is Medical Billing and Coding Service, Cost, and Reason to Outsource Medical Billing?


Various titles may be used to describe medical coders. Medical coder jobs are also known as:

·        Medical coding auditor

·        Medical coding analyst

·        Diagnostic coder

·        Medical coding specialist

·        Clinical coding officer


Are there some characteristics common to successful medical coders?

Unlike other professions, medical coders do not have any “typical” prototypes. The field embraces people of all identities, ages, and experiences. Medical coders share some common characteristics that make them successful. Strong ethical standards are essential because the patient data they manage is highly confidential.

One little mistake in a medical code can lead to much larger problems. Medical coders must also be meticulous with their work. As a result, they must also remain focused because their work is repetitive yet essential. Aside from being efficient and even-tempered, their work is often tied to reaching production and accuracy goals.


Is it essential to have skills in medical coding?

There are a few technical skills for medical coders that they need, but transferable skills are also necessary. The data comes from real-time analysis of over 25,000 medical coding job posts from the past year, which revealed some of the top skills employers are looking for.


Medical coding skills to Master:

·        Health Insurance Portability and Accountability Act (HIPAA) compliance

·        Medical coding

·        ICD-10

·        Customer billing

·        Health information technology

·        CPT coding

·        Inpatient coding

·        Anatomy and physiology

·        HCPCS coding

·        Clinical documentation


Medical coders need to be proficient in the following transferable skills:

·        Time management

·        Communication

·        Multi-tasking

·        Research

·        Computer literacy

·        Problem-solving

·        Microsoft Office®

·        Analytical skills

Some of those transferrable skills might make you a promising candidate for a career as a medical coder. The list of technical skills is what a formal education teaches you, so don’t let it intimidate you.


Are you thinking about becoming a medical coder?

The information you just read has helped you gain a basic understanding of medical coding, its skills, and the vital role these professionals play in the healthcare industry. Medical jobs are expected to grow strongly over the next decade, making it an excellent option for those searching for a job in the medical field. However, when considering a healthcare career, you need to be prepared for what lies ahead.


Requirements for becoming a medical coder?

A bachelor’s or master’s degree is not necessary to prove proficiency, though it can strengthen an individual’s career. It would be best if you had a solid foundation in physiology, anatomy, and medical terminology. If you’d like to work as a medical coder, you’ll need to complete a coding course.

Several community colleges offer coding training, and online learning centers offer this service. The majority of training programs are 18 to 24 months long. In addition, the American Association of Professional Coders, a credentialing body for medical coders, offers several medical coding courses.

It would be best to prepare for the certification exam to become a certified professional coder through your study program. The certificate proves your understanding of coding rules and your ability to translate patient charts into insurance billing correctly. Coders with less than two years of experience earn the CPC-A (apprentice) designation until they are fully qualified. In addition, your knowledge of physician offices (CPC), outpatient facilities (CPC-H), or payers (CPC-P) will be tested in AAPC examinations.

Certifications for specific medical specialties are available based on the type of service rendered, including evaluation and management, general surgery, and obstetrics and gynecology. The certification status must be maintained through continuing education.


What are CPT Codes? Understanding CPT Codes

CPT is a standardized set of codes used to report medical, surgical, and diagnostic procedures and services to various entities, including physicians, insurance companies, and accreditation organizations. Medical bills are billed electronically using CPT codes combined with ICD-9-CM or ICD-10-CM numerical diagnostic codes.

The CPT codes are used to submit claims to federal and private payers when rendering healthcare. As CPT codes provide a detailed description of a procedure or service, they eliminate subjective interpretations of what was delivered to the patient.


The American Medical Association (AMA) developed CPT® codes in 1966 to standardize reporting of medical, surgical, and diagnostic services and procedures provided in hospital and outpatient settings.

The evolution of healthcare – including the availability of new services and the retirement of outdated procedures – is a significant consideration. Every year, the AMA releases new, revised, and deleted CPT® codes and changes to coding guidelines. The AMA also releases more minor updates to various sections of the CPT® code set.

Moreover, the AMA updates CPT® terminology or medical language to reflect advances in medicine. Though the AMA owns the copyright to CPT®, it invites participants to contribute to the ongoing maintenance of the code set and welcomes feedback on the codes and code descriptors.


Understanding CPT® codes

CPT® codes are composed of five characters. In general, codes are numeric, but some codes include a fifth character, such as A, F, T, or U. These are some examples:

92526      Oral function therapy

0638T      Ct breast w/3d bi c-/c+ 


CPT® Code Types: A Quick Guide

Providers assign codes to every service or procedure they perform. It even includes codes for services and procedures not specifically named in another CPT® code, called unlisted codes.

The AMA has organized CPT® codes logically by classifying them into three types based on the wide range of services and procedures they cover:

CPT® Category I: Codes commonly used by providers to report their services and procedures comprise the largest body of codes

CPT® Category II: Additional tracking codes used in performance management

CPT® Category III: Emerging and experimental codes for reporting services and procedures


CPT® Category I:

Most CPT® codes are in Category I. There are a variety of existing services and procedures that are widely used and, where appropriate, approved by the Food and Drug Administration (FDA).

In general, Category I codes, which are typically represented by five characters, are arranged numerically. Codes are resequenced in one discrepancy from the expected order. In order to facilitate quick access to related codes – and help coders select the best codes – the AMA groups similar codes together. Resequenced codes occur when a new code is added to a family of codes, but there is no sequential number assigned to it.

Another exception to numerical code order involves evaluation and management codes (E/M codes). Although E/M codes begin with 9, they are printed first in CPT® code books, as you can see below in the code outline for Category I. E/M services are among the most frequently reported healthcare services, so the AMA chose this order. As with resequenced codes, this arrangement is intended for coding efficiency.


Codes for CPT® Category I fall into six main categories:

Evaluation & Management (99202–99499)

Anesthesia (00100–01999)

Surgery (10021–69990) The code range is further divided into smaller groups by body area or system

Radiology Procedures (70010–79999)

Pathology and Laboratory Procedures (80047–89398)

Medicine Services and Procedures (90281–99607)


CPT® Category II:

Four numbers and the letter F make up Category II codes, which providers can assign in addition to Category I codes. There is no reimbursement associated with Category II codes, unlike Category I codes.

The CPT® code book typically places Category II codes after Category I codes. These codes are listed as follows:

Composite Measures (0001F–0015F)

Patient Management (0500F–0584F)

Patient History (1000F–1505F)

Physical Examination (2000F–2060F)

Diagnostic/Screening Processes or Results (3006F–3776F)

Therapeutic, Preventive, or Other Interventions (4000F–4563F)

Follow-up or Other Outcomes (5005F–5250F)

Patient Safety (6005F–6150F)

Structural Measures (7010F–7025F)

Nonmeasure Code Listing (9001F–9007F)


CPT® Category III:

Category III codes, characterized by four numbers and a letter T, usually follow Category II codes in the code book. Category III codes are temporary codes used to identify new technologies, services, and procedures.

In Category III, temporary codes describing new services and procedures can remain for up to five years. They must meet Category I criteria, including FDA approval, evidence that the procedure is widely practiced, and evidence that it has proven effective. A new Category I code will be assigned to them. Providers can also eliminate Category III codes if they do not use them.

The AMA releases new or updated Category III codes semiannually via its website but publishes the deletions of Category III codes with the full list of temporary codes annually.


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