Medical coding is part of a reimbursement and reporting function within the health care industry. Codes are assigned by specially trained professionals called coders, or coding specialists. Coding specialists do not work directly with patients, but instead fulfill business responsibilities within health care. However, coding specialists must understand both the clinical side of medicine and the business aspect in order to assign codes.
Medical coding involves assigning numeric and alphanumeric codes to the diagnoses and procedures listed with a patient's medical record. Codes are assigned according to special coding rules and then listed with the patient's medical record. Assigned codes provide information for a variety of purposes such as reimbursement and billing, statistical reporting, resource usage and research.
The job duties of a coding specialist include reviewing patient medical records and clinician documentation to determine diagnoses and procedures. The coding specialist then uses specialized coding software to help assign the appropriate diagnosis and procedure codes. In some cases, the coding specialist discusses situations and documentation ambiguities with the physicians and clinicians in order to ensure correct assignment of codes. In some environments, a coding specialist may also assume billing responsibilities where she submits the codes on claim forms for reimbursement from insurance payers.
Coders generally work business hours in an office environment. Many coding specialists work in hospital department like the medical records or health information management, or in physician offices. Others enjoy employment in outpatient surgery centers, long term care facilities, psychiatric hospitals, insurance companies, health care consulting firms, medical research companies and even governmental health care agencies.
It is rare for health care organizations to hire coding specialists without education or training. Medical coding specialists generally complete certificate or diploma programs lasting a few months through community colleges or online programs. Others choose to complete an associate degree program in health information technology, which focuses on coding and reimbursement. Coding specialists wishing to advance into management may complete a bachelor's degree program in health information management.
Certification means receiving a professional credential, above and beyond education, generally through completion of an examination. Even though a voluntary process, most health care employers still require coding specialists to receive certification. Several respected professional organizations exist, like the American Health Information Management Association and the American Academy of Professional Coders, providing different levels of coding credentials based on experience and specialty area. For example, a coder specializing in physician office coding may obtain AHIMA's Certified Coding Specialist-Physician-based credential, or AAPC's Certified Professional Coder credential.
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