What is a Medical Coder?

Let's imagine for a moment that you were hiking with your family in the mountains and tripped over a rock, twisting your ankle and cutting your knee. You realize you cut your leg pretty deep and your ankle is very painful and difficult to walk on.

You call your doctor who says to come in right away and be seen. You check in at the front desk and they verify your address and insurance are the same and collect your insurance co-payment from you. The medical assistant takes you back to a room where she takes your blood pressure, heart rate and a brief history of the event.

When the doctor arrives, he asks about the injury, when your last tetanus shot was, if you are allergic to anything and what medications you are currently taking. He examines your knee and ankle and orders an x-ray of your ankle to rule out a fracture. He states the cut is deep enough to need stitches.

A radiology technician takes an x-ray of your ankle then returns you the patient room to wait for the results. While the x-ray films are being developed the doctor stitches up the wound on your leg.

The x-ray results are negative for a fracture but the ankle is sprained and needs support. The ankle is wrapped in an ACE bandage. You are told to ice it, elevate it, avoid straining it, and to take ibuprofen as needed for pain and swelling. You are to follow up in 10 days for suture removal and a re-examination of your ankle.

You return to the front office to make a follow-up appointment and the doctor types up a report of your visit on the computer.

Sound familiar?

This example is like most visits to the doctor's office in that you check in, see the doctor, possibly have tests done, are told what is wrong and are prescribed a treatment plan and then check out at the front desk when you are done.

The entire process required the assistance of the following employees:

a. Receptionist
b. Medical assistant
c. Doctor (or other healthcare provider)
d. Radiology technician

The employees you do not see but who are just as vitally important in making sure the physician is paid for the rest of the care provided to you include:

a. Medical coder
b. Medical biller

The remainder of this article will review the role of the certified medical coding professional in the doctor's office.

Once the medical report is completed, the medical coder will review the report to determine what services were rendered to the patient and what conditions or diagnoses the patient has. This information will then be reported to the insurance company so payment can be made to the provider.

Medical services and diagnoses are reported to insurance companies by assigning codes to each service and each diagnosis from a standardized code set created by and maintained by the American Medical Association (AMA) and World Health Organization (WHO).

A manual called the Current Procedural Terminology, which we prefer to call CPT is used to report services or procedures and the International Classification of Diseases, Ninth Edition, Clinical Modifications, which we most definitely prefer to call ICD-9-CM for short (and ICD-9 for shorter) is used to report diagnoses.

These codebooks contain too many codes to be memorized so the task of a medical coder is to understand how to navigate these manuals and match the appropriate code with the appropriate service and diagnosis. Manual navigation and code selection can be a daunting process and can reduce accuracy and speed so encoding software was developed as a remedy to this problem.

Encoders are software programs that increase speed and accuracy of code selection by using key search terms and then electronically searching the code sets for a final code selection.

Let's return to our example above. From the office visit scenario, we can see that this visit consists of the following services and diagnoses:

Services:

a. Office visit
b. Ankle x-ray
c. Stitches

Diagnoses:

a. Sprained ankle
b. Open wound, lower leg

By searching the CPT and ICD-9 code sets we determined the codes, used to describe each service and diagnosis, are as follows:

Services:

a. Office visit = 99214
b. Ankle x-ray = 73610
c. Repair, laceration, leg = 12002

Diagnoses:

a. Sprained ankle = 845.00
b. Open wound, lower leg = 891.0

These codes (without their descriptions) are then entered into a software program with an assigned dollar amount for each service. There are standard claim forms that are used when billing insurance companies and these codes are printed on these forms and either printed and mailed or electronically transmitted to the insurance company. The insurance will then process the claim and pay the medical provider.

As there are many medical specialties, cardiology (heart), pulmonology (lungs), radiology (imaging), neurology (nerves), general medicine (everything), dermatology (skin), otorhinolaryngology (ears, nose, throat) and many, MANY more, medical coders who have special knowledge in all these areas are needed to provide accurate coding of medical reports and assist providers in receiving payment for the care they provide to patients.

It is important for medical coders to have a sound knowledge of anatomy and disease processes as well as medical terminology. This knowledge enables them to read, with comprehension, the medical reports authored by the medical providers and assign the appropriate codes to them. If you are considering a career in medical coding, know that these are important areas of study you just cannot do without.

A recent salary survey of medical coders in the United States revealed that certified medical coders make anywhere from $41,000 to $54,000 a year with the average being around $48,000 annually. To read the salary survey article by AAPC go to: http://news.aapc.com/index.php/2012/09/salary-survey-2012-trends-show-growth-and-diversification.

Medical coding is a career field that is in high demand. With all the upcoming changes in the healthcare industry, medical coders will be in even more demand than ever before.

Medical providers love to help people feel better and live healthy lives. As such, there is something very fulfilling about assisting them to receive correct reimbursement for the services and care they render to their patients. If medical coding sounds like a career path you may enjoy, take the time to research it further.

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Aimee Wilcox, MA, CST, CCS-P is a Certified Coding Guru (CCG) for Find-A-Code. For more information about ICD-10-CM, ICD-10-PCS, and medical coding and billing please visit FindACode.com where you will find the ICD-10 code sets and the current ICD-9-CM, CPT, and HCPCS code sets plus a wealth of additional information related to medical billing and coding.

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