Medical Billing and the Test of Good Coding

Medical billing professionals have many tasks beyond medical billing, including medical billing database management, spreadsheets and basic accounting to name a few. What has become the most important aspect of medical billing, and arguably the most difficult part of the job, is the challenge of medical billing codes.

What makes coding in medical billing such a challenge? Many aspects, but first it’s important to understand the purpose of medical billing codes. Medical billing codes are what physicians submit to insurance companies or HMO’s (health maintenance organizations) in order to receive payment for each patient visit. Or, as it’s referred to in medical billing terms, each encounter.

Part of what makes medical billing coding for these encounters so challenging is that different medical billing codes are designated for various encounters, including treatments, tests, and diagnoses. In fact, simple complaints from patients, such as muscle pain and headaches, have their own medical billing codes.

The different combinations of medical billing codes indicate to the insurance company or HMO the patient’s ailments and what services the doctor performed. Ultimately, the purpose of these medical billing codes is to make payment fast and efficient. Medical billing codes should not require a written explanation.

While this medical billing system is great for the insurance companies and HMO’s, the sheer volume and various combinations of medical billing codes makes it challenging for the medical billing professional. Services-rendered medical billing codes or CPT’s (Current Procedural Terminology) must match the diagnosis medical billing codes or ICD’s (International Classifications of Diseases).

Now that you know the basics, make sure your medical billing is coded correction to make sure your reimbursements are full reimbursements and not just partials.

View all Articles by: Melissa Clark, CCS-P