Important Facts about Medical Insurance and Coding Click here to skip navigation
  • Some Important Facts About Medical Coding and Billing

    If you enjoy working with records and numbers, have an eye for detail, and would like to join the booming field of healthcare, consider pursuing a medical billing and coding career. Medical coding and billing specialists play an important role in the medical services industry. They keep accurate records of patients' symptoms, medical histories, medical procedures, treatments, exam results, lab or X-ray test results, diagnoses, and treatment plans. Some medical billers specialize in coding patients' medical procedures to ensure that insurance companies bill and process them correctly. They use a universally recognized classification system known as the International Classification of Diseases (ICD-10) index, published by the World Health Organization, to ensure compliance with federal regulations and insurance requirements. (1) Medical coding and billing specialists generally work in places like medical offices, clinics, hospitals, insurance companies and government agencies.

    Although some training programs offer just medical billing training, you should consider a training program that combines medical billing and medical coding classes into one program, since medical coding is the first step in the medical billing process. (1)

    Medical coding and billing schools typically offer instruction in topic areas such as anatomy and physiology, medical terminology, medical records management, computerized applications, and the standard industry coding systems and rules (HCPCS and CPT).

    HCPCS is the Healthcare Common Procedure Coding System. This set of standardized healthcare codes is maintained and updated quarterly by the Centers for Medicare and Medicaid Services, part of the U.S. Department of Health and Human Services. (2) HCPCS is used to describe the specific items and services provided in healthcare delivery. This coding is necessary for health insurance programs like Medicare, Medicaid, and others to ensure that insurance claims are processed in an orderly and consistent way. (3)

    The HCPCS consists of two main subsystems, known as Level I and Level II of the HCPCS. (2) Level I of the HCPCS is the CPT, which stands for Current Procedural Terminology. CPT® is a registered trademark of the American Medical Association (AMA). The CPT code set describes medical, surgical, and diagnostic services. Its intent is to communicate information about medical procedures and services uniformly among coders, physicians, patients, payers, and accrediting organizations for financial, administrative, and analytical purposes. CPT 2009 is the current version. (3) The AMA makes decisions about adding, deleting, or revising CPT codes and updates these codes annually. (2)

    Upon completion of your medical coding and billing training, if you want to pursue medical coding certification, the American Health Information Management Association (AHIMA) offers three certification exams for medical coders (CCA, CCS, and CCS-P). AHIMA was founded in 1928 to improve the quality of medical records and is dedicated to helping enhance the health information management profession through its leadership efforts in advocacy, education, certification, and lifelong learning. (4)