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Medical Coding involves a coder who assigns appropriate
codes to health care treatments or procedures performed
by professionals and prepares a document that includes all
details about treatments, claims and so on, so that during
medical billing appropriate bills and claims to insurance
companies can be made. The idea is to abstract all details
from the document prepared by the medical professional ,
assign appropriate codes and create a claim which can be
paid by the patient or insurance company.
To become an established medical coder one needs to
have thorough knowledge about human anatomy and
medical terminology. Also, one needs to be familiar with
current trending insurance plans, policies, benefits,
regulations, compliance and so on. Medical coding is
explained in detail in three resourceful books , ie, CPT,
HCPS level II and ICD9CM. These have codes and
guidelines which the medical coders use to assign to
specific cases in patients' treatment records. These are
then used to claim the treatment amount in the medical
bills. Assignment of correct codes emphasizes the need to
record service levels for procedures performed and keep
an account of supplies used to treat the patient. It is used
in a way to tally the physician's diagnosis with the
treatments and the medical bill. Not only this, medical
coders also have other responsibilities such as auditing
and refiling appeals of denied claims. The coder may also
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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.
Medical coders also act as an intermediary between
providers and patients in case of issues such as coverage
of claim and medical necessity. Medical coding has
become an upcoming choice for career. One needs to
undertake certified courses for medical coding to be able
to take up this career. The various courses that one can
take up are Certified Professional Coder(CPC), Certified
Inpatient Coder(CIC), CPC- H(outpatient), CPC
P(Payer) and so on. These courses open up several coding
related jobs like CPMA(Auditor), CPCOTM(compliance
officer) and Certified Physician Practice Manager
(CPPM®). Medical coders have job opportunities in
several health care facilities like doctor's clinic, surgery
centers, hospitals and such health care systems.
Some experienced coders have the ability to work at
home through an employer or as a contract worker.
Medical coding jobs involve detailed and intrinsic work.
Coders need to review patient's chart and history to
understand the diagnosis and correlate between the
diagnosis and the treatment provided. Any oversight of
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services or assignment of codes can lead to under
payment or over payment. These can attract legal charges
too. Hence medical coders have to be very diligent and
meticulous while coding these patient documents.
Another challenge that coders face is that codes keep
changing constantly. Hence they need to keep abreast of
the new codes and interpret the rules and regulations
accordingly. Only with a thorough understanding of
medical terminology, anatomy and physiologycoders can
be perfect in their work.