What Are the Functions of a Medical Coder?
Medical coders play a critical role within the health information industry. Their main job is to review a patient's health records and other supporting information in order to code and classify the patient's diagnosis and procedures. The assigned numerical code is entered into the appropriate database so health care providers can be reimbursed for their services.
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Features
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Medical coders conduct a comprehensive review of a patient's medical charts and relevant reports to verify the existence of all needed components, including a patient's health records, tests, laboratory results, operative reports, other procedures, necessary signatures, dates and other information that is included. They also are in charge of verifying that the concluding diagnosis correctly indicates the care and treatment delivered. Their coding must comply with standards implemented by the American Medical Association's Current Procedural Terminology, International Classification of Diseases manuals and reimbursement agencies, or insurance companies.
Function
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Medical coders must assign and input the correct diagnostic code to establish the amount of money a health care provider or facility gets reimbursed from the insurer. In order to maintain consistency, they must utilize standard classification systems, like ICD-9-CM/CPT/HCPCS/DRG/APC. The accuracy of codes is critical, as it serves as the foundation for maximum and timely reimbursement. Coders also directly impact the accreditation of the provider/facility, clinical decision-making, consistency of patient care, and research data and statistical information used by health care practices and local and federal agencies to recognize health-related dealings relating to the public.
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Identification
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Medical coders regularly communicate with other medical personnel, insurance companies, employees at other facilities, federal and state agencies, patients and their families. The intention of their correspondence is to exchange information, especially in the event a claim is denied. The function of a medical coder also includes explaining assorted insurance benefits and procedures to patients and other clients, keeping up with the policies of insurance providers and overseeing various in-house activities (such as bookkeeping, appointment scheduling and other executive tasks).
Types
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Medical coders typically work in an office setting or health care facility, though some may work from home. Their specific duties may vary according to their area of specialty. Within the medical coding arena, occupational titles include: coding specialists, coding coordinators, medical collectors, claims processors, claims analysts, claims reviewers, patient account representatives and electronic claims processors. The data they code and input also vary by the particular setting they work in. For example, a cancer registrar focuses on the accuracy of data pertaining to all types of cancers treated in health care facilities. They use a registry to retain information used for the purposes of research, patient followup and advancing public health care programs for the disease.
Education & Employment
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Medical coders need to have sufficient knowledge of anatomy and physiology, existing diagnoses, medical abbreviations and terminology, techniques and surgical procedures, and pharmacology. Additionally, they are required to be familiar with the official coding standards and rules instituted by the American Medical Association (AMA) and the Center for Medicare and Medicaid Services (CMS), which are used to identify and assign diagnostic and procedural codes.
Medical coders are usually required to go through a definite amount of training and hold the compulsory credentials, like an Accredited Record Technician's certification (ART) or Certified Coding Specialist designation (CCS), along with further requisites mandated by the American Health Information Management Association (AHIMA) and American Academy of Professional Coders (AAPC). Companies are more likely to employ coders who are Registered Health Information Technicians (RHIT), which means they have passed the AHIMA examination and have completed an associate degree program that is accredited by the Commission on Accreditation for Health Informatics and Information Management Education (CAHIIM).
According to the U.S. Department of Labor Occupational Outlook Handbook, "Employment of medical records and health information technicians is expected to increase by 18 percent through 2016 -- faster than the average for all occupations -- because of rapid growth in the number of medical tests, treatments and procedures that will be increasingly scrutinized by health insurance companies, regulators, courts and consumers."
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References
Resources
- Photo Credit Medical Coding Process (www.globaledgeusa.com)
