Medical Billing and Coding

Medical Billing and Coding

Medical billing and coding can be a satisfying career for someone with a tidy and logical mind.  An interest in medicine and science generally would be of great benefit in this field of work although is not absolutely essential.  You certainly do not have to know about the intricacies of various diseases, but just need to know how to pick out key information from patients’ records and transcribe that information into code form based on pre-worked out guidelines.

Medical codes are used for tracking various diseases by governments and for epidemiological studies, but in the main they are essential for the medical industry so that everyone concerned in healthcare gets paid correctly for their expertise and their services.
There are different systems of coding in operation;

  • for diagnostics,
  • for procedures,
  • for pharmaceuticals,
  • for topographical purposes.

In the area of pharmaceuticals, for example, codes are used to uniquely identify medications.  There is an anatomical chemical classification, (AT or ATC/DDD), administered by the World Health Organisation. There is a system of National Drug Codes (NDC), administered by the Food and Drugs Administration, and there is a wider Systematically Nomenclature of Medicine based on a hierarchy relating to abnormal anatomy, abnormal function, or etiology.

In the US a lot of medical treatment is paid for by means of insurance, and so a coding system has been established in order to facilitate and streamline the process. Of course, it is essential that the procedures or services performed for a patient are correctly identified, and given the right code before entering them into the system. Medical billing and coding embodies the skills that enable this to be done in a clear and logical manner.

The American Medical Association has approved the Current Procedure Terminology codes, or CPT, which are numeric, and easily computerised.  An example of a code might be 38221 = bone marrow biopsy.  Medical coders who work with Medicare or Medicaid must be acquainted with the Healthcare Common Procedure Coding System, or HCPCS, which is an alphanumeric system, and includes services, procedures, and supplies.  An example of this system is JO530 = injection of penicillin.
As a medical coder you might work in a hospital, doctor’s office, clinic, outpatient care center, or nursing home.  There is also the possibility of working for a home healthcare agency or insurance agency.  You should be careful though of agencies that promise you can work from home, as unfortunately a lot of these are scams.
Medical billing and coding involves setting out the costs of diagnosis, tests, and treatment, and submitting this information to insurance companies as an invitation for them to pay for services rendered.  Medical billing workers are encouraged to become certified by taking an appropriate examination such as the CMRS or RHIA exam.  The extent of the physical examination, the complexity of the medical decision making and the background history of the patient will all have to be taken into account in determining the precise level of expertise and service that pertained to any particular case.

As well as working directly for a health provider, there are increasingly, opportunities to join a growing industry of third party medical billing services that can help to reduce the provider’s work load.  There is though, in some quarters, concern over the maintenance of standards.

Medical billing and coding is a first class career choice, as there is little doubt that the health industry seems likely to continue to expand, and along with this will come the expansion of the area of administration of costs and the management of payments.

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