Medical coding specialists play an essential role in the business of healthcare. Using alphanumeric diagnosis and procedure codes, they communicate critical information about medical conditions and treatments. Coders translate medical terminology into a standardized format, allowing information to be transmitted accurately and efficiently between healthcare providers and insurance payors.
Correct coding ensures proper recording of a patient’s medical conditions, verification of the provider’s services, and appropriate reimbursement by payors for those services. Additionally, codes are used to monitor public health threats, such as diabetes or measles outbreaks, to track provider performance and to identify potential areas of financial or medical fraud or abuse within the healthcare industry. When coding is done properly, patients, providers, and payors all benefit.
Medical coding specialists rely on their knowledge of anatomy, medical terminology, health conditions, and medications to assign diagnostic and procedural codes for each patient encounter. They must review a patient’s medical record and will, at times, talk to the patient’s healthcare provider or research payor policies to uncover missing information.
Medical coding is a dynamic occupation, as evidenced by the health care community’s implementation of the ICD-10 code set as of October 1, 2015. ICD-10 is more advanced than the decades-old ICD-9 code set that it replaces, and the skills of medical coding specialists will be in greater demand than ever with this transition.
Medical coding specialists work in a variety of settings, both clinical and non-clinical. Clinical settings may include:
- Physician offices and group practices
- Surgery centers
- Skilled nursing and other long-term care facilities
- Dental offices
- Home health agencies
- Mental health facilities.
Some medical coders work outside of the clinical setting at insurance companies, independent billing and coding services, consulting firms, public health organizations, and government agencies.
Most medical coding specialists work full time in a business office environment, spending a majority of their time abstracting clinical data from patient charts. They use a variety of resources to code correctly for services, supplies, and diagnoses, including the International Classification of Diseases (ICD) and Current Procedural Terminology (CPT) codebooks; coding software; websites, such as InnerBody; and medical providers and colleagues.
While working hours for coders usually parallel business hours, some 24-hour facilities may schedule coders for evening or overnight shifts. In recent years, the number of at-home work opportunities, especially among non-clinical employers, has increased; however, these positions generally require several years of proven work experience.