Medical Coding and Billing

Medical coding is nothing but to be put in a simple way, it is like translation. A coder’s job is to take something like a doctor’s diagnosis, prescription for a particular medication in one way and then translate it with as much accuracy as possible into a certain numeric or alphanumeric code. There is a corresponding code already present for every injury, diagnosis and for each medical procedure.

There are a lot of codes that have been made for several medical procedures, outpatient procedures, and injuries or its diagnoses. Here is a quick example of how a medical billing and coding services work.

Suppose a patient walks into a doctor’s office with a severe cough, high production of mucus, and also with fever. The nurse asks the patient about their symptoms and then goes on to perform some initial simple tests, and then the doctor comes and he examines the patient thoroughly and concludes that the patient has got bronchitis. The doctor will then prescribe certain medication to the patient.

This visit of the patient to the doctor and every detail of this visit have been recorded by either the doctor himself or someone present in the health care provider's office. Then the medical coder’s job is to translate every little bit of the needed and the relevant information in that patient’s visit into a certain numeric and alphanumeric codes and then these codes are used in the billing process of the patient.

A medical coder must be familiar with a number of sets and subsets of code.There are two main types of medical coding.

 International Classification of Diseases or ICD

 Current Procedure Terminology or CPT

International Classification of Diseases or ICT codes mainly deals with a patient’s injury or his sickness.

Current Procedure Terminology deals mainly with what functions and services a doctor or any healthcare provider performed on the patient or for the patient.

This code is actually a universal language between the doctors, hospitals, medical insurance companies, insurance clearing houses, government offices, and any other health specific organizations. Each and every code set has an individual and unique set of guidelines and rules or regulations. After the medical coder enters the appropriate code into a form or software program the coding process will automatically end and then the coded report is passed on to the medical biller.

Medical Billing

Medical billing is quite simple as outsource medical billing services receive information from the medical coder and then process a bill for the medical insurance company commonly known as claim.

If we consider the example, then after the patient calls the doctor and schedules an appointment for his sickness then the medical billing will start from here.

The biller receives the code and comes to know about the patient’s symptoms, doctor’s diagnosis, and his prescription and then makes a claim. The biller sends this claim to the respective insurance company who evaluates it and returns it to the biller who again evaluates it to see how much the patient owes.

  Modified On Feb-12-2019 08:33:43 AM

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