Medical Billing and Coding

In today’s world of increasing demand for healthcare insurance products, the medical biller and coder is more important than ever. A person who works in the medical billing and coding field is responsible for translating a doctor’s record of services performed for a patient into terminology that can be understood by the health insurance payer. It is also a field that is easy to enter if you enjoy working in an office environment. Plus, the pay tends to increase with experience.

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At a Glance

Medical Billing and Coding TrainingOther Job Titles: Medical Coding & Billing Specialist, Medical Billing Clerk, Billing Coordinator
Salary Range*: $20,800-$49,920; Average $31,000; Median $33,000
Education/Training Required: High school to bachelors degree however employers prefer those with associate’s degree and medical billing and coding certificate
Desired Skills/Aptitude: attention to detail and working with health information systems (computers)
Certification/Licensing: Certification available through AAPC
Locations with Best Opportunities: Texas, Arizona, Nevada, New Mexico
Employment Outlook: Faster than average through 2018
Opportunities for Advancement: Experience, cross-training, moving into management

What is Involved in Medical Billing and Coding?

Medical billing and coding is sometimes separated into two distinct jobs. Medical coders are responsible for taking incoming documentation from a healthcare provider facility and “coding” it so that it can be processed for payment by a health insurance company.

The coder uses a set of standards for translating documents from a healthcare provider into a claim that the insurance payer can understand. There are three main standards or guidelines:

  • Current Procedural Terminology (CPT)
  • Healthcare Common Procedure Coding System (HCPCS)
  • International Statistical Classes of Diseases (ICD)

CPT codes are defined and maintained by the American Medical Association (AMA). The publication assigns codes to all procedures used by medical practitioners on patients. For example, an office visit has a CPT code of 99201. HCPCS codes are based on CPT codes except used for billing to Medicare and Medicaid which are the government healthcare payers for those living on financial assistance or social security.

ICD codes can be thought of as the diagnosis for a condition when the patient visits a healthcare provider. This code set was created by the World Health Organization and is intended to form a standard way for classifying diseases or other ailments. ICD codes are complex and the U.S. is currently on ICD-10 however there are some organizations still using ICD-9.

Medical billers are the thread between entities of patient, insurance companies, and healthcare providers. Their responsibility is to send healthcare claims to the appropriate payer which will be an insurance company or government-funded healthcare assistance program such as Medicare and Medicaid.

The Workplace

Medical billers and coders can work in just about any healthcare provider or insurance facility there is. These include:

  • Doctor’s offices
  • Health insurance administration centers
  • Hospitals
  • Dental offices
  • Nursing homes
  • Pharmacies

At these locations, medical coders are responsible for assigning the right codes for procedures performed before sending the claim documentation to the insurance payer.

Education and Certification

Employers prefer those with at least an associate’s degree and a certificate awarded through an approved medical billing and coding program. Some seeking to enter this field will get an associate’s degree in any discipline and then augment it with a medical billing and coding certificate. There are also associate degree programs for this field.

Although not specifically required, employers also desire certification of its billers and coders. The most widely-known provider of certification is the AAPC (American Academy of Professional Coders). They offer several certifications all related to coding but with specialties. For example, for physician’s offices there is the Certified Professional Coder or CPC and for hospitals and outpatient facilities there is the Certified Professional Coder-Hospital Outpatient or CPC-H.

Salary Source: Bureau of Labor Statistics, May 2012.