What Is Medical Billing and Coding?


Quick Answer

Medical coding is the process of converting diagnoses and treatments into codes. Medical billing involves sending claims to insurance companies or other responsible parties for payment. Depending on the office, medical billing and coding can be separate jobs or one job.

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Full Answer

When patients are seen by a medical professional, every procedure or evaluation must be documented. Medical coding uses these documents and assigns a code to each step. Medical coding uses several different types of codes including Current Procedural Terminology (CPT), International Classification of Disease (ICD-9) and Healthcare Common Procedure Coding System (HCPCS) codes. There are different codes used depending on the level of care provided, as well as equipment or supplies needed to provide the service. These codes provide the basis for a medical bill or claim to be created.

Medical billing takes the codes assigned during the medical coding process and changes them into charges to be billed to insurance companies or the patient. Medical billing follows the charges to insurance companies to make sure the medical facility receives reimbursement for the services provided. This may require getting clarification from physicians about diagnoses or procedures to ensure the proper billing and to minimize rejection from insurance companies.

As of 2014, training is not required by law for medical billing and coding, but finishing a certification course is encouraged. In offices where medical billing and coding are performed by separate employees, the employees often work together to make sure the invoices are accurate. Medical offices can also outsource billing and coding. In small offices, an employee that handles billing and coding could also be required to assist patients.

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