Although in some small clinics, the same person will do both the billing and the coding, medical billing and medical coding are two separate careers that you can train for. Medical coding involves using diagnostic information provided by the physician to assign a particular code for insurance billing purposes. These codes, currently called ICD-10 codes in the U.S, are used internationally (other countries may use the ICD-11 version) and they tell the insurance company the specific diagnosis for a patient so the company can ensure that the current procedural code or office visit code, called a CPT code, and related charges are appropriate for the diagnosis. Although medical coding is frequently Incorporated into patient chart software, there may still be a need to review codes before they are submitted for reimbursement by insurance companies.

Medical coding differs from medical billing in that a medical coder works directly with the healthcare professionals but does not always work with patient records. On the other hand, medical billing is done in an office separate from the providers but patient medical records are frequently viewed in this field.

Here is an example of when a medical biller and a medical coder would be involved in a patient visit:

Sarah hurt her ankle and went to see her primary care doctor. The doctor worked with the medical coder to provide an appropriate type gnosis that would allow insurance to cover Imaging and necessary treatment for Sarah’s ankle. After completing the visit, the diagnosis codes and the procedural codes, including those of the office visit and the X-ray, are submitted to the medical biller for processing and submission to Sarah’s Insurance Company. Once the insurance company returns the payment, the medical biller will then enter the payment information into the system and create a statement to send to Sarah explaining how much she owes on the balance. If the insurance company denies payment of the claim, the medical coder can review the charge and ensure that it most accurately reflects the patient encounter. Correction and resubmission after a claim denial can lead to a reversal of the original denial, providing payment to the doctor and the clinic for their services. The medical biller can also work with Sarah to provide for a payment plan or use of any charitable forgiveness funds if that is available.

While medical billing and coding are complementary fields, they may not always be performed by the same person. In the following section, we will discuss the varying options for certification and education in each one of these specialties.

Possibilities in the Field of Medical Billing and Coding

There is no requirement for formal certification or licensure in the field of medical billing and coding. In fact, in very small practices, medical billing and coding may be done by office staff without any formal training whatsoever. However, there are certification programs in medical coding and in medical billing that increase your marketability by providing you with formalized exposure to the worlds of medical coding and medical billing as well as providing you with introductory training in medical ethics, hipaa requirements and other patient services topics. Many of these certification programs can provide complete training in less than a year and are very popular with people looking to re-enter the workforce or make a career change.

With a career in medical billing and coding, you can work in many different environments. Some people choose to work from home and work on contract for different organizations and small clinics who purchase their services. Others may find themselves working within a clinical or hospital facility to provide for the needs of a single organization. medical billing and coding, because it interfaces with third-party payers, can also provide careers within insurance companies in positions that process submitted claims (Bryan University, 2018).

As with many other medical support careers, medical billing and coding specialists are becoming more common. For example, some medical coders and billers work specifically with oncologists and cancer treatment organizations to review patient records, pathology reports, and other diagnostic and procedural notes in order to ensure coverage of services by the patient’s third-party payer. Other billing specialists, such as those who work with anesthesiology practices, would work to ensure coverage and billing of services provided by their employers, which may involve coordinating with hospital billing and coding specialists as some anesthesiologists have private practices that contract with the hospital for their services.

Different levels of certification exist for medical coders. These include the Certified Coding Associate (CCA, requires high school diploma), Certified Coding Specialist (CCS, the next step up after CCA and 1 year of experience) and Certified Professional Coder (CPC, highest level of knowledge about CPT codes and billing). All of these certifications can be supported by certification programs at local community colleges and do not require a degree. However, Health IT degrees from two-year or four-year colleges can be helpful to provide the level of training that will ensure a more successful outcome on the certification exams.