Medical Billing vs Medical Coding, What’s the Difference?

Medical coding and medical billing are two of the reimbursement systems within the healthcare organization. The professionals who perform these tasks are known as medical coders and medical billers, respectively. The work of medical coders and medical billers is to analyze medical treatments received by patients while at a healthcare facility to coordinate payments from insurance companies and patients. In this article, we will discuss the difference between medical coding and medical billing. However, it is important to have a brief understanding of what medical coding and medical billing entail.

What is Medical Coding?

Medical coding is a way of converting healthcare diagnosis, procedures, medical services, and equipment into universal medical alphanumeric codes. The healthcare diagnosis and procedures are taken from medical record documentation of physician transcription notes, laboratory, and radiology results. Medical coding professionals ensure the codes are applied correctly by abstracting the information from physician documentation and assigning the appropriate codes.

Medical codes explain a patient’s visit. Whether a patient was seen for routine check-up or disease condition treatment, each procedure and service receive a specific code.

The use of medical coding helps in uniform documentation between medical facilities and it also aids the efficient transfer of a huge amount of information into simple codes. 

The coding specialist translates this information into precise medical codes for each one of thousands of possible services, which will be needed to be valued for reimbursement purposes.

However, in a situation where the coder is uncertain about a patient’s records, they will consult medical staff or physicians to receive more details regarding the patient’s health condition.

Medical coders are also known as coding specialists they are considered part of the medical team and they are often seen working closely with management, healthcare providers, and payers. Since medical coding requires a particular discipline, as stated the important task performed by a medical coder is to review clinical statements and also assign standard codes using Current Procedural Terminology (CPT), International Classification of Disease 10th edition Clinical Modified (ICD -10- CM is authorized by the World Health Organization (WHO) and used as a source for diagnosis codes in the USA) and Health Care Procedural Coding System level II (HCPCS Level II) classification system.

In other to promote and use medical coding effectively, the medical coder is expected to check the patient’s medical record (the doctor’s transcription notes, laboratory test, any imaging, and other vital documentation when deemed necessary).

Medical coding can be considered as an alliance role. A medical coder usually works directly for, or with healthcare organizations in alliances with healthcare physicians, administrators, Nurses, Therapists, laboratory technicians, and other healthcare providers. They take information from the medical record documentation and assign the appropriate diagnosis and procedure codes, according to the American Academy of Professional Coder (AAPC).

Medical coders and medical billers are not one in the same. Medical coders use classifications systems to assign different codes, including the International Statistical Classification of Disease and Related Health Problems.

What is Medical Billing?

Medical billing can be described as a process in which healthcare providers submit, follow up, and appeal claims with the health insurance company to receive payment for services rendered by the healthcare provider. The services rendered can include things such as testing, diagnosis, treatments, and procedures. Medical billing is responsible for the translation of healthcare service into a billing claim.

The medical billing process usually involves a third-party payer, the third-party payer can be an insurance company or the patients. The process involves updating financial records, calculating bills and charges for patients, and completing financial transactions to settle any outstanding debt.

The medical claims are billing invoices for medical services rendered to patients. The medical biller in a healthcare facility follows the claim to ensure the practice receives reimbursement for the service rendered by the healthcare provider.

It is the responsibility of a medical biller to negotiate and arrange for payment between the patient, healthcare provider, and the insurance company. The medical biller ensures the healthcare provider gets paid for the service rendered. For the medical biller to carry out their work effectively, they need to gather all information about the patient and the patients’ procedure and then compile the information gathered into a bill for the insurance company. The bill is called a “claim” and it can contain a patient’s medical history, demographic information, and insurance coverage information.

Medical billing can be considered an autonomous role. Medical billers usually work as facilitators. They facilitate communication between several parties necessary to balance the billing process. They process and follow up claims.

Medical billers and medical coders always share information. The medical billers take the procedure and diagnosis codes used by medical coders and thereby using the information to create claims.

So, while both roles are vital to proper healthcare reimbursement, they are very different roles and are not interchangeable.

View all Articles by: Kathryn Etienne, CCS-P