The Basics of the Medical Billing and Coding Process

Find out more about the basics of this essential healthcare career

If you are detailed-oriented, organized, and have a mind that thrives on solving puzzles, a career as a medical billing and coding specialist might be the right career path for you. We’ve created this overview of the profession to give you an idea of what it involves. It’s also a good idea to get a sense of the day to day work a medical billing and coding professional does.

General facts about these important healthcare roles

  • Some specialists work in physicians’ offices, while others work in healthcare facilities including hospitals, rehabilitation centers, nursing homes, and clinics.
  • There can be more than 250 people involved in the billing process for a single claim. This includes healthcare professionals from nurses to coders.
  • Billing and coding mistakes can be costly for the practitioners who provide services. Because of inefficient billing practices, U.S. doctors lose an estimated $125 billion in income each year. Billing errors account for 25–30 percent of lost income for medical practices.
  • A medical and billing specialist needs to be familiar with over 100 medical terms to complete the coding process. Knowing common prefixes and suffixes that go with the most common body types and problems makes it possible to do this job more efficiently.

Disease classification

The modern coding system has roots that go back more than 100 years. The Bertillon Classification (named for a French statistician) dates back to the late 1800s, when it became the standardized system that 26 countries used to track and classify deaths. Later, the World Health Organization of the League of Nations decided to track diseases as well, starting in 1949.

The current International Coding System is the ICD-10-CM. It contains about 68,000 codes (it would be impossible to memorize them all!). The system is updated about every 10 years, and each time, the number of codes increases significantly. For example, ICD-9-CM, which preceded ICD-10-CM, contained a mere 13,000 codes.

To ensure they are using the right codes for a diagnosis or procedure, medical billing and coding specialists need to refer to doctors’ notes or work closely with the facility’s medical records department. This takes time and patience, but it is important to record the most accurate information possible in order to successfully process a claim.

Difference between coding and billing

Medical coding and billing are two separate tasks that come together to ensure that the practitioner is reimbursed for the services they provide. Coding assigns the specific disease, illness, symptom, and/or treatment codes to be used on the claim forms. Billing includes prepping and submitting claims to insurance companies, given those codes, and following up about any fees that go unpaid.

Often, the same person will complete both tasks—especially in a workplace such as a physician’s office. In a larger facility, like a hospital, separate people may handle these two tasks. Intrigued? Learn more about the differences between the two roles.

We hope this overview is helpful as you do your career-related research. Being a medical billing and coding specialist can be an interesting and gratifying career, with a number of different challenges. Whatever career path you decide to take, we wish you the best!

This article is part of the weekly blog of the American College for Medical Careers in Orlando, FL. We care about the health and well-being of all our students. For more information about our various professional training programs, visit us online.