Medical coding is a little bit like translation. Coders take medical reports from doctors, which may include a patient’s condition, the doctor’s diagnosis, a prescription, and whatever procedures the doctor or healthcare provider performed on the patient, and turn that into a set of codes, which make up a crucial part of the medical claim. Medical Coding Specialists are employed in hospitals, physicians’ offices, health care insurance agencies, nursing homes and health clinics. Employment is expected to increase by 14% from 2016 – 2026 with a 2018 median annual wage of $40,350 (Bureau of Labor Statistics Employment Projections).
There are three types of code that you’ll have to become familiar with as a medical coder:
The first of these is the International Classification of Diseases, or ICD codes. These are diagnostic codes that create a uniform vocabulary for describing the causes of injury, illness and death. This code set was established by the World Health Organization (WHO) in the late 1940s. It’s been updated several times in the 60-plus years since it’s inception. The number following “ICD” represents which revision of the code is in use. For example, the code that’s currently in use in the United States is ICD-10-CM. This means it’s the 10th revision of the ICD code. That “-CM” at the end stands for “clinical modification”.
Current Procedure Terminology, or CPT, codes, are used to document the majority of the medical procedures performed in a physician’s office. This code set is published and maintained by the American Medical Association (AMA). These codes are copyrighted by the AMA and are updated annually.
Healthcare Common Procedure Coding System (HCPCS), commonly pronounced as “hick picks,” are a set of codes based on CPT codes. Developed by the CMS (the same organization that developed CPT), and maintained by the AMA, HCPCS codes primarily correspond to services, procedures, and equipment not covered by CPT codes. This includes durable medical equipment, prosthetics, ambulance rides, and certain drugs and medicines. HCPCS is also the official code set for outpatient hospital care, chemotherapy drugs, Medicaid, and Medicare, among other services.
Medical Coding versus Medical Billing
Because these positions work in tandem with one another, some small offices hire people to do both jobs. The primary difference, however, is that medical coders translate medical services into codes, while medical billers translate the claims from these codes into reimbursements from insurance and patients. Medical coders work with physicians and health care facilities while billers work with insurance companies and patients in addition to physicians and health care administrators.