Medical Coding


Medical coding is the process of taking clinical and diagnostic information and converting it into insurance formats. This is of course done in accordance with nationally established standards. Medical coders should have extensive knowledge of medical insurance documentation techniques and processes. Medical coders are also referred to as medical records and health information technicians.

The Medical Coding System

Medical coders utilize a nationally recognized coding system. They must make sure that they are using the most current and correct codes so that they comply with insurance requirements and federal regulations.

In addition to use for insurance purposes, medical classification systems are also used when conducting the statistical analysis of diseases and the various therapeutic actions to be taken. Codes can also help in the direct surveillance and monitoring of epidemic and pandemic outbreaks of diseases and illnesses.

Coding can require the following types of tasks by a specialist:
  • Abstracting from patient records

  • Analyzing patient documentation

  • Using the ICD-9, CPT, and HCPCS coding systems

  • Putting together statistical data

  • Correlating diagnostic and procedural codes

  • Submitting insurance and Medicare claims

  • Coordinating medical finance practices.

Medical Coder Training

Medical Coding Specialists look at medical records and assign codes to the various procedures and diagnoses listed. Their basic task is to take the verbal description of a disease or injury and transform it into a numerical system. The coding system provides information for the reimbursement of health care claims, health statistics, and research.

Medical Coders need to become familiar with:
  • Anatomy

  • Physiology

  • Medical terminology

  • Diagnostic and procedural terminology

  • Diagnostic lab tests

  • Pharmacology

  • Various medical office procedures

  • Medical finance.

Specific training in the analysis of medical records and the assigning of codes is the main focus. Medical coders have a great responsibility and good training programs emphasize completeness, accuracy, confidentiality, quality, and ethics.

Medical Coding Certification and Job Prospects

Medical coders must take and pass the national certification examinations of the American Academy of Professional Coders or those of the American Health Information Management Association for proper certification. Medical coders are employed in various health facilities including:
  • Hospitals

  • Clinics

  • Nursing homes

  • Surgery centers

  • Consulting companies

  • Insurance companies

  • Government agencies

  • Computer software companies.

There are outpatient coders, inpatient coders, medical coding specialists, coding analysts, and claims analysts.

Accurate medical coding is vital as health care evolves. There is greater scrutiny placed on the reimbursement process and accuracy of health care claims. As such, the demand for qualified medical coders has increased dramatically in recent years. There are a number of part-time, evening, and online certification courses for those interested in working in this field.

By Aadika Singh           


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