Differences Between Medical Billing and Coding

Although they’re often partnered together, medical billing and medical coding are actually two distinctly different careers. Some smaller medical practices and clinics may combine the two into one position, but that should be considered the exception rather than the rule, Those who have the long term goal of owning their own business also often fulfill the education requirements for both careers in order to be more flexible when seeking private clients. Here’s a look at both, the differences between medical billing and coding, and the common areas the careers share.

Medical Coding

Medical coding entails examining patient records to establish what treatment the doctor or other healthcare provider performed, and then assigning the proper diagnostic or procedure code to the patient record. Current Procedural Terminology (CPT) is the standard used for the specific procedure code, and the International Classification of Diseases (ICD) is used to determine the diagnosis code. As in all healthcare positions, accuracy is vital because this is the information that will be sent to the insurance company for claim processing. Coders often have to check with other staff members or patients to confirm the information, or obtain more details on the exact treatment as well as to confirm the accuracy of the coding being entered into the patient’s record.

Medical Billing

Medical billers enter the treatment and diagnosis codes into the insurance claim software in order for the claim to be processed accurately. They use software specifically developed for this purpose so they must also be fluent in the use of the billing software and the claims procedure and requirements for each insurance carrier. Medical billers often take patient insurance information directly from the client and are sometimes responsible for explaining benefits, copays, deductibles, and other insurance details. Once the billing information has been submitted to the insurance carrier either by mail or electronically, the medical biller must monitor the claim to ensure payment has been made and contact the insurance company if there is a delay.

Work Environments for Medical Billers and Coders

Both medical billers and medical coders work in an office environment within the healthcare industry, most often in physicians’ offices and hospitals. They share the same basic salary range, and both use patient information, confirm details with medical personnel and interact with insurance carriers. When an insurance claim is rejected or denied, they each have to talk with the insurance company representative to determine the cause. They also have to talk to the affected patients and inform them about the status of their claims.

Where Medical Billing and Coding Overlap

Here are some areas where the two careers may overlap:
  • Both positions require a professional demeanor and an ability to interact with people from all walks of life and in all types of health.
  • Both billers and coders must both be fluent in the terminology of the CPT and ICD, so a complete knowledge of the anatomy as well as medical terminology are required.
  • They also must have attention to detail and be accurate in their work, as it is vital that the terminology be correct.
  • As with all workers in the healthcare industry, medical billers and coders must be discrete and respectful of the personal information they have access to.

Difference Between the Careers

The main difference between medical billing and coding is the point in which they interact with the patient and their information. While a medical coder confirms the exact procedure and diagnosis in order to enter it into the patient record, the medical biller takes that information, confirms insurance details with the patient and submits the claim to the insurance company.

Education Requirements

Because the two career paths of billing and coding are closely intertwined, the education requirements are too. A medical billing and coding certificate program typically takes one year to complete and prepares the student for a position as a medical coder. You will learn both code systems required by the healthcare industry as well as medical software and billing codes. An associate’s degree program will take two years and will also teach you medical terminology general healthcare courses, medical payment terminology and insurance processes. You will also learn these types of skills:
  • Data management
  • Maintaining and analyzing patient information
  • Credit and collections
  • Office procedures
  • records systems management
  • Software usage and information technology
Usually an associate’s degree program will also include an internship, so you will get hands on experience as a medical coder or biller before you actually enter the field. This is a great way to find out if you really like the job, and it may also provide opportunities to network with other professionals.

Professional Certification

Although there is no legal requirement to become certified as a medical biller or coder, it is highly recommended, as certification is often the standard used for employment criteria.
The American Academy of Professional Coders (AAPC) has three levels of certification you can test for; two years of experience is required before you can sit for the exam:  
  • Certified Professional Coder (CPC)
  • Certified Professional Coder—Hospital Outpatient (CPC-H)
  • Certified Professional Coder—Payer (CPC-P)


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