When you visit your doctor, your medical insurance provider will receive a bill that contains CPT code (CPT stands for stands for Current Procedural Terminology) for the office visit and a diagnosis code for the condition treated. If an X-ray is performed or blood is taken, those services would also be represented by CPT codes on your bill.
There are over 9,800 CPT codes – one for every type of health care service provided by health care practitioners or facilities. There are another 14,000 International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) codes for medical diagnoses. There are also Healthcare Common Procedure Coding System (HCPCS) Level II codes for medical supplies and services.
Medical coders spend their days reviewing medical records 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. The coder must also understand private payer policies and government regulations for accurate coding and billing.
By some estimates, inaccurate or incomplete coding costs the average doctor thousands of dollars a year in lost payments. Without competent coders, providers run the risk of losing revenue.
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.
Medical coders work in every type of health care facility, including doctor’s offices, surgery centers, hospitals and health care systems. Some experienced coders have the ability to work at home through an employer or as a contract worker.
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 for 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.
Salary Range and Outlook
Coders earn an average of $35,000 to $50,000 per year. Coders with specialty credentials tend to be on the higher end of that scale and can earn substantially more based on experience and specialty (averaging a little less than $55,000 per year).
According to AAPC, certified coders earn 21% more than non-certified coders. Many employers now require certification for newly hired coders.
AAPC publishes an annual salary survey.
There are no standardized educational requirements to become a medical coder. However, concerns about billing accuracy, particularly for Medicare patients, have turned the spotlight on coding. Doctors have been accused of overcharging Medicare because they submitted bills with the wrong codes.
Becoming a certified professional coder 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.
Training in coding skills is available at many community colleges and through online learning centers. Most training programs can be completed in 18 to 24 months. AAPC offers a list of medical coding courses.
To become certified, you must pass an examination administered by AAPC. Coders with less than two years’ experience receive a CPC-A (apprentice) designation until their experience is complete. AAPC offers examinations that test your knowledge of coding for physician offices (CPC), outpatient facilities (CPC-H) or payers (CPC-P).
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. Continuing education is required to maintain certified status.