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When you visit your doctor, your medical insurance provider will probably receive a bill for CPT code “99211.” That code tells the insurer that you had an “office visit.” If you got an x-ray or had blood taken, those services would also be represented by CPT codes on your bill.
There are over 9,000 CPT (Current Procedural Terminology) codes – one for every type of health care service provided by health care practitioners or facilities. There are another 13,500 ICD-9 codes for medical diagnoses, plus more codes for medical supplies and for various health care settings.
Medical coders spend their days sorting through patient charts to assign these codes and ensure that the health care providers they work for are properly reimbursed for their services. Coding accurately is not easy – the coder must carefully read the doctor’s and nurse’s notes to determine exactly what services the patient received.
Like taxpayers who fail to declare all the deductions they’re entitled to, coders often fail to bill for services performed. By some estimates, inaccurate or incomplete coding costs the average doctor thousands of dollars a year in lost payments.
Because physicians and hospitals depend on accurate coding to receive proper reimbursement, the role of the coder is becoming more valued. Coders once learned their work “on the job.” Now you can train to become a Certified Professional Coder (CPC), a designation that demonstrates to potential employers a certain level of coding skill and accuracy.
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Medical Decoder 14 Sep 2009 [pdf, 201 KB]
Medical coders work in every type of health care facility, including doctor’s offices, surgery centers, hospitals and health care systems. Some coders have their own freelance businesses, working from home and billing for their services on an hourly basis.
Coding is extraordinarily detail-oriented work. The coder must carefully review the patient’s chart to learn the diagnosis and itemize every service that was provided. If a service is overlooked, the provider will not receive payment for it. If the coder chooses the wrong code, the provider may have to return any excess payment or face legal charges of “overbilling.”
Codes change constantly, so coders must keep abreast of new rules and interpretations. A solid understanding of medical terminology, including anatomy, is also required.
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There are no standardized educational requirements to become a medical coder. Many current coders started their careers as medical assistants, learning how to code simply because their employer needed someone to do it.
Concerns about billing accuracy, particularly for Medicare patients, has turned the spotlight on the coding function. Doctors have been accused of overcharging Medicare because they submitted bills with the wrong codes.
Becoming a Certified Professional Coder designation tells potential employers that you understand coding rules and have demonstrated a high level of accuracy in translating patient charts into correctly coded insurance bills.
To become a Certified Professional Coder (CPC), you must pass an examination administered by the American Academy of Professional Coders. Coders with less than two years’ experience receive a CPC-A (apprentice) designation until their experience is complete. Different examinations test your knowledge of coding for physician offices, outpatient facilities, or payers.
Annual recertification through continuing education is required to maintain certified status.
Because coding is based on the nature of the medical services provided, certification is becoming available for specific medical specialties, including evaluation and management, general surgery, and obstetrics and gynecology.
Coders earn an average of $30,000 to $40,000 per year. Coders with specialty credentials can earn as much as $85,000 a year.
According to the American Association of Professional Coders (AAPC), certified coders earn an average 17% higher salary than non-certified coders. Many employers now require certification for newly hired coders.
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Last updated: December 9, 2013
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