Career Guide: Medical Billing and Coding
If you are fascinated by the subject of physiology and want to work in the medical field but prefer to work behind the scenes, then becoming a medical coding specialist may be the perfect career choice for you.
The Career Explained
Medical coding is the transformation of medical diagnosis, procedures, services, and equipment into universal medical alphanumeric codes. These codes are assigned after a medical coding specialist interprets doctor notes and laboratory and radiologic results. Once assigned, the documentation becomes a claim that is submitted to and paid by insurance carriers.
The first medical coding system (The Bertillon Classification of Causes of Death) was introduced in the late 1800s and was used to classify and track mortality.
Today, the industry has changed quite drastically from a fee-for-service job to a more value-based career. As Adrienne Younger of Ardent Health Services puts it, “Medical coders are not just there to code a record. They’re actually looking out for the patient outcome. They’re identifying things they may not have identified before because now they think it needs to be brought to the attention of somebody else on the team.”
Entering the Industry
Becoming a medical coding and billing specialist can be a very fulfilling career, one that doesn’t require a large time investment to enter. The education required for an entry is typically only 20 months in length and is available through either in-person or online courses. Subjects covered include anatomy, physiology, medical terminology, clinical documentation, and coding and billing procedures.
The types of facilities that require medical coding specialties include outpatient clinics, medical specialists’ offices, and hospitals. The Medical Specialties program teaches the essential knowledge and skills that employers in the healthcare industry are looking for when hiring members for their team.
Although a part of a patient’s healthcare team, medical coders largely work independently and often times from their own home office. However, interaction with fellow coders, billers, physicians, and ancillary office staff is essential. Also, internal or external auditors will periodically check for accuracy and completeness.
A Day in the Life
Receiving doctor’s notes and patient files, documenting the services rendered, and preparing insurance reimbursement statements is, in short, what a medical coding and billing specialist does in their day-to-day work.
Here’s a scenario for a more detailed picture of the process:
Jon, a medical coder for a mid-size family clinic, sits down at his desk with a batch of patient files from yesterday. Flipping through the stack he sees notes regarding earaches, a skin biopsy, 28-week gestational check-up, x-ray results for a broken finger, immunization updates, and a follow up after outpatient surgery.
Jon opens his first file and begins to review the documentation so he can understand the patient’s assigned diagnosis and the procedures that were performed during the visit. He interprets the notes, abstracts key information (physician name, date of procedures, etc.), and begins to translate all of this into universally used medical codes.
Relying on his education, experience, and essential code books, Jon assigns specific alphanumeric codes onto the patient’s chart. He then enters the data into a billing system that is linked with insurance companies, allowing his clinic to receive correct reimbursement. By the end of the day, Jon has reached his documentation quota and submits his production report.
Job Statistics and Growth Outlook
The Bureau of Labor Statistics states that in 2014, there were 188,600 medical records and health information technician jobs. Looking forward to the year 2024, this industry has a projected growth rate of 15 percent, which is much faster than the average.
There are two explanations for this faster-than-average demand for specialized medical coders. First, it’s due to the expected increase in population age. Baby Boomers are now retiring and heading into their golden years. As they age, more medical visits and procedures will need to be coded to keep up with demand.
The second reason (and it’s a big one), is that the coding practices that have been in place for more than 30 years have recently been updated. In years past, 19,000 diagnostic and procedure codes were used in the industry. However, just in the last couple of years, that number has skyrocketed to 142,000 various codes, due to a much-needed update in the coding system.
This larger compendium of codes will serve to provide greater specificity in coded reports which translates into better care for patients. This newer system will demand the healthcare industry employ a significant increase in educated and dedicated coding specialists.