FAQ – M.E. Harris School for Medical Coding

Frequently Asked Questions

Medical coding is a specialized profession within the wider field of healthcare administration.
Professional medical coders review the documentation contained in patients’ medical records, then they translate the written documentation into universally accepted, industry-standard medical code.
- Diagnosis codes that describe a patient’s condition at the time services were rendered are translated into codes found in International Classification of Diseases, 10th Edition, Clinical Modification (ICD-10-CM) books
- Procedures are translated into codes contained in the indices of Current Procedural Terminology (CPT) code books used for outpatient services
- Durable medical equipment, ambulance, supplies, drugs and other services are translated into codes found in Healthcare Common Procedural Coding System (HCPCS) Level II code books
These codes are used to submit claims to third party payers, and to gather statistical information, both by tracking incidents of specific diseases, and by discerning developing trends in treatment protocols.
Accurate medical coding is essential to the healthcare industry.
- It is how claims for payment are reported for appropriate reimbursement of provided medically necessary services.

Professional certified medical coders essentially act as translators.
They review a patient’s medical record as written by physicians, therapists, nurses, technicians, and other healthcare providers.
After comparing the documentation to the standards established by the American Medical Association, the Centers for Medicare and Medicaid Services, and contractual agreements with commercial health insurance plans, certified medical coders abstract the pages of written information, and they convert it into standardized codes.

While many coding professionals have strengthened their career by earning their bachelor’s degrees and master’s degrees, neither is required for a career in medical coding.
What is required is a solid understanding of anatomy, physiology and medical terminology.
It is also highly recommended for serious coders to complete a medical coding course of study, pass the CPC exam and earn their certification as a Certified Professional Coder, or CPC®.

Certified Professional Coders, or CPCs®, are in high demand because employers know that these individuals can perform the job of medical coder with the utmost proficiency.

How to Become a Medical Coder?

Certified medical coders have to pass a national exam to prove their professional understanding of medical terminology, anatomy and physiology, and the practice of medicine.
- American Academy of Professional Coders (AAPC)
  - The basic credential offered by AAPC is the title of Certified Professional Coder (CPC)
  - Specialty certifications are also offered by AAPC, such as Certified Professional Coder-Hospital Outpatient (CPC-H), or Certified Interventional Radiology Cardiovascular Coder (CIRCC).
- American Health Information Management Association (AHIMA)
  - AHIMA offers the designation of Certified Coding Specialist (CCS), and Certified Coding Specialist-Physician-Based (CCS-P).
- They should understand the components that are required to be documented in order for a code to be assigned to a given procedure or condition.
- No layperson can pass a medical coding certification exam without accredited training and experience.
  - Formal programs of study are offered through community colleges, private schools, and online study courses.

What is a Medical Coder’s Function?

To begin, coders must have a thorough knowledge of anatomy and medical terminology.
- It is also important to become familiar with different types of insurance plans, regulations, compliance, and the coding community’s three critical resource books: CPT®, HCPCS Level II and ICD-10-CM along with their corresponding codes and guidelines.
- Using code books the medical coder assigns correct codes to record the service levels for the procedures performed and to account for supplies used to treat the patient during an encounter with the physician.
- Proper assignment of ICD-10-CM codes corresponds with the physician’s diagnoses and completes the “story” of the patient’s illness or injury.
In addition to assigning ICD-10, CPT®, and HCPCS codes, today’s medical coder may be involved in a wide variety of coding-related activities.
The coder may audit and re-file appeals of denied claims.
The coder may also educate providers and recommend the appropriate application of federal mandates and compliance that require providers to use specific coding and billing standards through chart audits.
He/She may also act as an advocate for the provider and patient in issues of coverage and medical necessity.
Starting a career in medical coding opens a number of coding-related jobs like Certified Professional Medical Auditor (CPMA®), Certified Professional Compliance Officer (CPCO™), and Certified Physician Practice Manager (CPPM®).

Where can Certified Coders Work?

Professional certified medical coders are employed by
- Hospitals
- physician group and individual practices
- skilled nursing facilities
- laboratories
- outpatient clinics
- ambulatory surgical centers
- home health agencies
- durable medical equipment suppliers
- and mental health facilities
When medically necessary healthcare services are provided, medical coders are employed.
After they have mastered their core competencies, certified medical coders ply their trade in numerous settings in which they build successful and rewarding careers.

What is the difference between Medical Coding vs. Medical Billing?

Medical billing and medical coding are two related disciplines.
- Professionals in each field use similar skills to achieve similar results, but the methods they use, and how they pursue their goals, are different.
Medical billers
- focus on providing accurate, timely reimbursement based on the codes used
- knowledgeable about commercial insurance requirements
- how to assemble a clean claim
Medical coders
- are less concentrated on reimbursement issues.
- Their role is to provide the most complete picture possible of a medical encounter usually dealing in a wider variety of codes, adhering more to the ideal of coding theory.
- In a large professional setting where the two professions are separate, medical coders are more concerned with compliance to universal meanings of codes.

Still have

questions?

Send a message
(917) 586-6983