Medical Biller and Coder Careers

medical biller and coder careers
  • Medical Billing and Coding are two essential backbones of the Revenue Cycle Management
  • Medical Coding is used to standardize patient diagnosis, procedures, and services in a language used in the billing process
  • Billers and coders are two distinct professions but work in sync with one another

Medical Coders and Billers work closely with one another and are key fundamental players in the entire Revenue Cycle Management. They are different in reality as to their job description but work hand in hand to keep the wheel of management turning. They are the backbone of the entire process who vigilantly monitor the flow of events in the cycle.

Medical billing and coding have a different language that they utilize in translating diagnosis and procedure made by the physician

Medical Coding And It's Codes

Medical coding begins with a patient encounter ensuring every detail of the insurance holder to be complete for a hassle-free claim submission. A coder’s work involves reviewing a patient’s medical record and history of visits, translation of the doctor’s notes, diagnosis, and procedures into their corresponding codes and constant communication with the paying insurance company and the physician. A medical coder himself should be investigative in the details presented to him and must do his best to translate these information to their proper codes. The coder’s work should be done with a hundred percent honesty and integrity to avoid claim denials and possible fraud from an incorrectly documented encounter. Time is of the essence in medical coding to maintain cash flow in the system.

The ICD 10 codes

ICD-10 refers to the tenth edition of the International Classification of Diseases, which is a medical coding system chiefly designed by the World Health Organization (WHO) to catalog health conditions by categories of similar diseases under which more specific conditions are listed, thus mapping nuanced diseases to broader morbidities.

ICD-10-PCS stands for the International Classification of Diseases, Tenth Revision, Procedure Coding System. As indicated by its name, ICD-10-PCS is a procedural classification system of medical codes. It is used in hospital settings to report on inpatient procedures.

ICD-10-CM stands for the International Classification of Diseases, Tenth Revision, Clinical Modification. Used for medical claim reporting in all healthcare settings, ICD-10-CM is a standardized classification system of diagnosis codes that represent conditions and diseases, related health problems, abnormal findings, signs and symptoms, injuries, external causes of injuries and diseases, and social circumstances (source:

Many countries have already started adapting the ICD-10 to continue alignment with the international standards on disease coding.

The Healthcare Common Practice Coding System (HCPCS)

The National Library of Medicine describes HCPCS as “a collection of standardized codes that represent medical procedures, supplies, products, and services”. The codes are utilized to facilitate the processing of health insurance claims by Medicare and other insurers.

The Current Procedural Terminology (CPT) Codes

Known to be under HCPCS Level I, CPT codes are a set of codes used in the health industry to describe the procedures done to a patient. It is an effort to standardize the services done to an admitted patient or in an outpatient setting. It is continuously updated every year to keep up with the evolution of the field of medicine and to even eliminate those procedures that are no longer done.

Level II HCPCS codes on the other hand are used for the other terms of products and services not included in the Level I HCPCS system. The Current Dental Terminology is under the Level II HCPCS.

Medical Billers

When a patient has successfully registered for his encounter, a medical biller’s job is to extract all “billable” information for submission of claims and to make sure to follow up on those claims for reimbursements. If ever a part of the encounter is not claimable to the insurance, he also sees to it that copayments are to be shouldered by the patient to keep the revenue stable. Just like a medical coder, he also keeps in constant communication with the providers and health insurance companies to get pre-authorization approval prior to encounter.

Depending on the size of the health institution, one person can perform both roles of a medical coder and a biller but when the volume becomes so much for one person to handle there will be a need to perform these tasks separately by 2 or more staff. A small practice or a clinic handled by a physician can be managed by one staff member who can function in both roles as long as that staff member is efficient, detail-oriented, and keen to see the entire picture of the entire revenue cycle management. Fault finding is a skill found useful if one wishes to venture into these careers.

Workwise, all healthcare facilities are advised to have medical billers and coders, especially the larger ones, and for those who attend chronic cases such as dialysis centers, nursing homes, palliative care, and rehabilitation centers.

For a medical coder, it is beneficial if a person has some knowledge in the medical field to understand fully the story behind a patient encounter. Critical thinking is a must in both specialties, however. Training is available for these careers and offers competitive pay depending on how skilled coders and billers are.

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