What Is Medical Billing and Coding?

Medical billing and coding is the system used by hospitals, doctors, and other healthcare providers to send bills for payment in insurance companies. In the past, claim forms were very different for each insurance company, leading to loss and confusion on the part of healthcare professionals. Today, medical billing and coding has become much more standardized so that doctors and hospitals can receive payment from any insurance company.

This effort at uniformity began with the American Medical Association’s endorsement of a five-digit coding system known as the Current Procedural Terminology code or CPT. The CPT designates a unique five-digit number of every type of medical procedure available, so that by coding these procedures in the office with these numbers the doctor’s staff can easily bill the insurance company for the correct amount.

medical billing and coding

This makes sense when you consider that among both doctors and insurance providers the same procedure may be called several different things, or the same name may apply to more than one procedure. With a unique five-digit number, however, there is no need to worry about naming a procedure; that number will only be associated with a single action, no matter what it is called in the doctor’s office or at the insurance company.

These codes are classified into levels or groups so they are easily accessible to those who must fill out the claim forms. For example, the numbers 99200 to 99299 are reserved for various types of office visit, so a medical coder can quickly look up “office visits” and determine the proper code to use.

There are different codes for different types of office visits; for example, 99211 would be used when a physician does not see the patient who is only there for a routine shot. 99201 is used for a new patient workup involving a physician. There are also codes for other types of visits, most of which depend on who sees the patient and the amount of time spent on care.

Codes are also used when a doctor or hospital is audited by Medicaid or Medicare or asked to provide proof of services by an insurance company. Correct coding is crucial not only for billing but also to ensure that the hospital or doctor’s office can provide documentation of the services performed, especially if those services were performed under an agreement with a federal or state program.

It is clear the medical coding and billing is a very important part of running a hospital or doctor’s office. Who performs this valuable service and how do they learn to do it well?

Medical coding and billing is performed by medical coders, people who have been trained to quickly identify and code medical procedures. This training is best done in a program that focus on integration of computer software with medical coding practices, although it is possible for a medical coder to be trained partially or completely on the job.

However, most doctor’s offices and hospitals prefer to hire people who are already trained in medical coding and need little time to learn the quirks of a new setting before becoming productive. Most places also want someone who has been certified as a medical coder, which proves that the person has a full understanding of medical coding procedures.

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