What Does a Medical Coder Do?

Medical coding companies play a crucial behind-the-scenes role in the healthcare industry, providing essential services that ensure accurate and efficient reimbursement processes, standardized data management, and regulatory compliance. Although they often operate discreetly, these companies are instrumental in maintaining the financial health of healthcare providers, optimizing revenue cycles, and facilitating streamlined communication among various stakeholders. These companies are the backbone of healthcare organizations; therefore, healthcare providers want to collaborate with professional coders. Nevertheless, this article will explore significant points, such as what a medical coder is and how to become one, as well as the essential functions of medical coding companies.

What Is a Medical Coder?

A medical coder is a healthcare professional who assigns standardized codes to medical diagnoses, procedures, and services. These codes are essential for various purposes, including reimbursement, billing, research, and statistical analysis. Medical coders work behind the scenes, analyzing medical documentation and applying the appropriate codes based on established coding systems.

Types of Codes Used

There are several types of codes used in medical coding. The two primary coding systems are: International Classification of Diseases (ICD):
The ICD is a globally recognized coding system maintained by the World Health Organization (WHO). It provides a standardized way to classify and code diseases, injuries, symptoms, and other health-related conditions. The current version is ICD-10, with ICD-11 being adopted in some countries. ICD codes consist of alphanumeric characters and follow a hierarchical structure. They provide detailed information about the disease’s location, severity, and associated complications.
Current Procedural Terminology (CPT):
CPT is a coding system developed and maintained by the American Medical Association (AMA). It is primarily used in the U.S. for reporting medical procedures and services provided by healthcare professionals. CPT codes provide a standardized way to describe and bill medical services, including surgeries, consultations, laboratory tests, radiology procedures, etc.
Healthcare Common Procedure Coding System (HCPCS):
HCPCS is a coding system used in the United States to identify and bill for additional healthcare services not covered by CPT codes.
It is divided into two levels:

• Level I: These codes are identical to CPT codes and are used for reporting physician services.
• Level II: These codes are alphanumeric and represent supplies, equipment, medications, and other services provided by non-physician healthcare professionals.

How do you Become a Medical Coder?

AAPC describes these steps to become a medical coder.

Step 1: Obtain a High School Diploma or Equivalent

To pursue a career as a medical coder, you must have at least a high school diploma or a General Education Development (GED) certificate. Focus on subjects such as biology, anatomy, mathematics, and computer science during high school, as these will provide a strong foundation for future medical coding studies.

Step 2: Pursue Postsecondary Education

While a postsecondary degree is not always a requirement to become a medical coder, it can significantly enhance your job prospects and earning potential. There are several educational paths you can take:

• Associate Degree Programs
• Bachelor’s Degree Programs
• Certificate Programs

Step 3: Gain Practical Experience

While pursuing your education, gaining practical experience in medical coding is crucial. Look for opportunities such as internships, externships, or part-time jobs in healthcare facilities, medical billing companies, or coding departments.

Step 4: Obtain Coding Certification

Although certification is not mandatory, it is highly recommended for medical coders. It demonstrates your competence and proficiency in the field, making you a more competitive candidate for job opportunities.
The most recognized certifications include:

• Certified Professional Coder (CPC)
• Certified Coding Specialist (CCS)
• Certified Coding Associate (CCA)
• Certified Inpatient Coder (CIC)
• Certified Outpatient Coder (COC)

Step 5: Seek Employment Opportunities

With the proper education, practical experience, and certifications, you are ready to enter the job market as a medical coder. Employment opportunities can be found in various healthcare settings, including hospitals, clinics, physician offices, insurance companies, government agencies, and coding and billing companies.

Responsibilities of a Medical Coder

Reviewing patient medical records: Analyzing clinical documentation to identify diagnoses, procedures, and services provided.
Applying appropriate codes: Utilizing coding manuals and software to assign accurate ICD-10-CM, CPT, and HCPCS codes.
Ensuring compliance: Adhering to coding guidelines and regulations set forth by governmental agencies, such as the Centers for Medicare and Medicaid Services (CMS).
Internal audits: They review coded medical records to ensure accuracy, consistency, and compliance with coding guidelines.
External audits: Responding to audits conducted by government agencies or third-party payers to verify coding accuracy and adherence to regulations.
Revenue cycle management: Collaborating with billing and finance departments to facilitate accurate reimbursement and minimize claim denials. If you get interested in the ICD-10-CM, CPT, and HCPCS coding audit,MedsIT Nexus medical coding services can assist you better.

Where do Medical Coders Work?

Hospitals: Within a hospital setting, medical coders work in diverse departments, such as inpatient coding, outpatient coding, emergency department coding, and surgical coding.
Physician Offices: Many medical coders work in private clinics or group practices. They review patient charts, encounter forms, and superbill forms to assign codes for services provided.
Consulting Firms: Medical coding consultants may work independently or for consulting firms, providing coding services and expertise to various healthcare organizations.
Insurance Companies: Some medical coders are employed by insurance companies to process claims submitted by healthcare providers. They review the documentation and ensure that the services rendered are appropriately coded for billing and reimbursement.
Government Agencies: Medical coders can find employment opportunities with government agencies like the Centers for Medicare and Medicaid Services (CMS) or the Department of Veterans Affairs (VA).
Remote Work: With technological advancements and electronic health records, many medical coders can work remotely or from home.
However, AAPC describes the work settings of Certified coders such as