Who Knew That Medical Coding Required So Much Translating

by  Find-A-Code™
Apr 12th, 2023

Medical coders and billers wear many hats. They are data entry specialists; they are medical professionals; they are even translators to some degree. Translators, you ask? Absolutely. Medical codes are not as static and straightforward as they appear to be. A lot of translating is required to get from a clinician's original notes to a payer actually making payment.

When we say 'translation', we are not referring to converting from English to Spanish and Portuguese, etc. It is a different kind of translation involving multiple things: medical terminology, clinician intent, and payer requirements.

The medical coder or biller needs to pull in information from multiple channels, decipher what it all means, and turn it into a set of codes that can be used to bill payers. If just one part of the process goes south, the result could be incorrect codes that prevent timely payment.

The Medical Terminology

Medical coding and billing specialists undergo pretty thorough training before they can be certified. A significant portion of that training is devoted to medical terminology. Here's just one example: the medical suffix 'itis'. It might mean nothing to you. But to a coding or billing specialist, it refers to inflammation.

Appendicitis is inflammation of the appendix. Arthritis refers to inflammation of the joints. Tonsillitis is diagnosed when the tonsils are inflamed. The list goes on and on, but you get the point. Why does this matter to medical coders and billers?

Clinicians use all sorts of medical terms that most people have never heard of, let alone understand. Coders and billers need to know these terms in order to translate clinician notes into accurate codes.

Understanding Clinician Intent

Doctors, nurse practitioners, physician assistants, and other clinicians take notes whenever they treat patients. Their notes sometimes include assigned medical codes. Other times, clinicians simply take notes without even thinking about codes. In the end, it is the medical coder's responsibility to take everything found in a clinician's notes and make sense of it by assigning the correct codes.

Medical codes essentially take the place of the clinician's narrative. They eliminate the need for a doctor or nurse practitioner to explain every little detail of a patient's treatment in order to satisfy insurance companies.

To get it right, medical coders and billers need to possess a certain knack for figuring out clinician intent by deciphering their notes. That is not necessarily an easy task. Sometimes, a doctor's intent is buried so deeply in their notes that finding it is like digging for diamonds.

Adhering to Payer Requirements

The proverbial icing on the cake for medical coders and billers is adhering to payer requirements. This is easily illustrated in the difference between dental procedure codes (CDT) and common procedural (CPT) codes. It used to be that insurance companies would accept CDT codes from dental practices. Most will not these days.

Why does that matter? Because dental practices still use CDT codes to track patient treatments, procedures, etc. But before payers can be billed for services rendered, those CDT codes must be translated into CPT codes. It is an extra step but one that is absolutely necessary. Otherwise, dental practices have a challenging time securing payment.

To say that medical coding and billing is complicated is to state the obvious. It has made more complicated by the fact that coders and billers need to act as translators between providers and payers. Things are sometimes lost in translation. And when that happens, the entire process just becomes more difficult. It is no wonder skilled coders and billers are so valuable to the healthcare industry.