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Coders most often review the work of the physician, apply modifiers, and check for errors in CPT code bundling or ICD-9(Diagnosis Code) appendage.
There are a number of sets and subsets of code that a medical coder must be familiar with, but for this example we’ll focus on two: the International Classification of Diseases, or ICD, codes, which correspond to a patient’s injury or sickness, and Current Procedure Terminology, or CPT, codes, which relate to what functions and services the healthcare provider performed on or for the patient.
These codes act as the universal language between doctors, hospitals, insurance companies, insurance clearinghouses, government agencies, and other health-specific organizations.
For every injury, diagnosis, and medical procedure, there is a corresponding code.
A patient walks into a doctor’s office with a hacking cough, high production of mucus or sputum, and a fever.
The biller takes all of this into account and creates an accurate bill, which is then passed on to the patient.
In the case of a patient being delinquent or unwilling to pay the bill, the medical biller may have to hire a collections agency in order to ensure that the healthcare provider is properly compensated.Coding accurately and within the specific guidelines for each code will affect the status of a claim.To get a better look at medical billing, let’s rewind the example we used earlier.A nurse asks the patient their symptoms and performs some initial tests, and then the doctor examines the patient and diagnoses bronchitis.The doctor then prescribes medication to the patient.Every part of this visit is recorded by the doctor or someone in the healthcare provider’s office.It’s the medical coder’s job to translate every bit of relevant information in that patient’s visit into numeric and alphanumeric codes, which can then be used in the billing process.Every code set has its own set of guidelines and rules.Certain codes, like ones that signify a pre-existing condition, need to be placed in a very particular order.There a few different options when it comes to becoming certified and we have links to the different options on this site.Certification does not guarantee you a place in the coding workforce but it does place you above much of your competition.