Medical Billing Cycle - Healthcare

Medical Coding

What is Medical Coding?

Medical Coding is converting the diagnosed diseases, performed procedures, medical services and durable medical equipment’s into universal alpha numeric codes by using ICD 10-CM(Alphabetical index and tabular list), CPT and HCPCS Level II book.

It is a conversion of medical records into the medical codes. Medical coding is nothing but assigning the medical codes to diseases and procedures by seeing medical records.

Why Medical Coding is important in Revenue Cycle Management?

Medical coding is done to use it for research and statistical purposes, because having uniform data allows efficient research, investigation and tracking of data.

Patient goes to the hospital, doctors treats the patient. We don’t know exactly how to control the cost and provide the quality healthcare to the patients.

So when we do medical coding, we will know the statistics like

Why lot of people getting disease and what diseases are common?

Once they have standard uniform data (statics), government can take proper decision to improve healthcare of the patient and also they can take preventive measures to avoid certain diseases. So it is a vital to code medical records.

As we know that in United States of America almost all the medical expenses will be covered through medical insurances. Medical coding methodology is used for billing insurance companies in order to reimburse the payment for the healthcare service provided and also to maintain uniformity standards. We need to bill the claim in standard format i.e. through HCFA (Physician billing) or UB 92(Hospital billing) form. All the insurances accept the Medical claims only through HCFA or UB 92 form.

Let us see the medical coding importance in billing the claim to insurance companies.

In United States of America, whenever the patient visits physician office, the conversation between the doctor and patient will be recorded. Which will be then converted into medical reports (also known as office notes) from the help of medical transcription team (But nowadays most of the providers do this process on live which is known as Virtual Transcribe).

Once the demo entry team captures(key) the patient details into the billing software for reimbursement, the medical coding team comes into picture.

Medical coders require an additional skills in order to intepretate procedure, disease and medical services from the medical records.

Medical coding team plays an very important role and it is one of the most sensitive of the revenue cycle, because the accurate medical coding increase the higher reimbursement from the insurance companies. Suppose if the claim coded is  inaccurate from the medical coding team, then the claim will be denied from the insurance company. So medical coding team plays an very important role in revenue cycle in increasing higher revenues for health care providers.

What does Medical Coder do?

Medical Coder will check the patient medical records to review the provider diagnosed diseases and performed services to patient. Once they have the data, they will assign and sequence the universal alphanumeric codes with the help of ICD 10-CM(Alphabetical & Tabular list), CPT and HCPCS II code book resources.

Medical coder main role is to follow the rules(Compliance) and guidelines set by the federal and assign the appropriate code for billing the claims to the insurance companies.

What Knowledge is required to learn the Medical Coding?

To learn the medical coding everyone must have the basic medical knowledge. Because the medical coding is done by seeing the medical records as well as by seeing the CPT, ICD 10-CM and HCPCS Level II(which will be completely in the medical terms) books.

If you don’t have a basic medical knowledge, to know, or to understand, what exactly the provider diagnosed and performed the procedures, then you may end up with improper coding. So it is very important or necessary to learn the following skills, before starting up medical coding training.

  1. Human Anatomy and Physiology
  2. Medical Terminology
  • Prefixes list
  • Suffixes List
  • Root words List

How to become a Medical Coder?

To become a successful medical coder, we need to learn the following 3 set of Medical coding books.

This set of Medical coding resources is completely in medical terms, so as discussed earlier first you should have a knowledge of medical Terminologies, human anatomy and physiology to understand and succeed as a medical coder.

This set of Medical coding resources is completely in medical terms, so as discussed earlier first you should have a knowledge of medical Terminologies, human anatomy and physiology to understand and succeed as a medical coder.

  1. ICD 10-CM
  2. Alphabetical Index
  3. Tabular list

It is a standard methodology used for coding the diagnosed diseases of the patient from the ICD 10-CM Medical coding book. There are more than 65000+ diseases, which are classified and this standard methodology is used to assign a code for diagnosed disease and patient condition from the above coding books.

  • CPT (Current Procedure Terminology)
  • HCPCS (Health Care Common Procedure Coding System)

What is the Scope of Medical coding?

As we know the health care industry is one of the fastest growing sectors in the United States of America.

Since the health care cost is very high in United States of America, the majority of American’s have health insurances to cover their health care services. This healthcare industry is much diversified and full of job opportunities in every segment(Providers, Medical biller and Payers).

The number of Medical coding job opportunities in USA is more than 10000+ on LinkedIn , 8800+ in Indeed and 4800+ in Glass-door as of 05/21/2019.

Medical coder pay scale?

The demand for the medical coding are in very high in today’s job market. The entry level medical coder especially the certified professional coders(CPA and CPC) are in huge demand with higher pay scale of up to $40k and this pay-scale can reach more than $70k, if you start gaining more experiences. The average pay scale for a medical coder is $18.83 per hour.

Let us see some of the states mean wage salary annually of medical coder and  job growth by 2026: With the above BLS data, we can easily say the employment is expected to grow faster at a rate of 15.6% by 2026 and the scope of medical coding is at boom in the Unites states of America.

StatesMedical coding
average pay scale annually
Medical coding
Job growth by 2026
in Percentage
New Hampshire$43.01k14
New Jersey$60.1k8.1
New Mexico$39.2k12.9
New York$48.4k16.3
North Carolina$39.7k20.1
North Dakata$45.5k23
Rhode Island$45.1k6
South Carolina$41.7k15.3
South Dakota$42.7k8.6
West Virginia$40.1k7.9