Medical Coding – The First Step to Medical Billing

Medical billing and medical coding go hand in hand and can seem very confusing until you learn how they work with each other.

Medical coders take the procedures and services performed by doctors, hospitals and clinics and translate those services into a series of assigned medical codes that each carry a revenue amount that will be reimbursed when the form that the medical coder has filled out is completed, documented and submitted for reimbursement by the medical biller.

There are codes for every conceivable type of encounter and even codes for having no code for the procedure. Whether it is a test, service, procedure, treatment or ongoing care, the service performed by the physician must be documented in the form of a number on the claim form. These codes are CPT4 codes and almost always consist of a 5-digit number. The most common complaints of headache or upset stomach even have codes.

The American Medical Association (AMS) developed the codings. The coding system is called the CPT system and it stands for Current Procedural Terminology to tell the health insurance companies or government entities the reason why a patient was seen and what services were performed so that the provider can get paid.

Once the coding is done, the medical billing form is sent to the medical biller to make sure the coding is accurate, proper documentation is attached and all services rendered (logical flow of services) is on the forms. The form is submitted and the insurance company or Medicare sends reimbursement for the procedures or services to the physician.

View all Articles by: Melissa Clark, CCS-P