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Medical Billing vs. Medical Coding: What's the Difference?

By Steve Smith

The information presented here is true and accurate as of the date of publication. DeVry’s programmatic offerings and their accreditations are subject to change. Please refer to the current academic catalog for details.


April 24, 2024
6 min read

The term “medical billing and coding” might make it sound like the professionals who work in this part of healthcare all do the same thing; but in reality, medical billers and medical coders have very different responsibilities that support the care of patients, the functionality of insurance processes and keeping facilities up and running smoothly.

In examining medical billing vs. medical coding, we’ll start off by defining each of them and carefully examining their similarities and differences. If you’re considering pursuing a non-clinical role in healthcare, explore how a career as a medical biller or coder may be a good fit for you. 

What is Medical Billing?

Medical billing is an administrative process in healthcare that deals with patient encounters. A patient encounter could be anything from a routine doctor’s office visit to a major surgery. The medical billers make sure healthcare providers are reimbursed by insurance companies, government-sponsored health plans and other payers in the revenue cycle. In some cases, patients might be billed directly for any portion of their medical claim that is not covered by their insurance plans.

The medical billing process takes place in two phases: front-end billing and back-end billing. In front-end medical billing, patients are asked for their insurance identification at the time they’re seen in the healthcare setting. While the patient is waiting to be seen by medical staff, the biller checks the status of the patient’s insurance to make sure that coverage is in place and address any questions that may arise. Back-end billing includes a series of steps that take place after the reimbursement claim has been submitted. 

A medical biller has to keep tabs on a lot of different things. Some of the daily tasks you might find in medical billing vs. medical coding might be:

  • Insurance coverage verification

    Before creating or submitting a claim, a patient’s eligibility for health insurance benefits is confirmed, along with any co-payments that patients may be responsible for.

  • Generating and submitting claims

    Medical billers create and submit claims for reimbursement by payers, such as insurance companies or government-sponsored coverage plans. 

  • Working with medical coders

    If corrections need to be made, the biller will work with a coder to review the codes that have been assigned and implement any changes.

  • Preparing patient billing

    This will typically include all the remaining costs of a patient’s care after identifying the amount covered by insurance.

  • Following up and handling disputes

    Medical billers are typically responsible for tracking the progress of insurance claims and working to resolve disputes that may arise. By resolving these issues promptly, the healthcare facility can avoid a lengthy delay in receiving payments or reimbursements.

What is Medical Coding?

Medical coding is the classification process that take place before medical billing. Medical coders, who are also known as coding specialists, gather information about each patient encounter from physicians’ notes, laboratory results or other sources, and assign specific alphanumerical medical codes to each item.

Medical coders study and use 3 primary classification systems in their work: The World Health Organization’s International Classification of Diseases (which encompass ICD-10 and ICD-CM) diagnostic codes, Current Procedural Terminology (CPT®) codes and Healthcare Common Procedure Coding System (HCPCS) codes. Typically consisting of 3-7 digits, these codes allow medical coders to document diagnoses and procedures with remarkable accuracy. 

ICD codes

ICD-10 diagnostic codes are implemented to classify a patient’s symptoms and conditions, and deconstructing the way an ICD code is built reveals just how accurately they can do that. The first 3 characters (a letter and 2 numbers) classify the disease or health condition. The next set of numbers describes the cause of the disease, how severe it is or where it is located on the body. For example, the code H50.622 indicates a an inferior oblique muscle entrapment in the left eye.

Specifically used to record diagnoses made in the outpatient setting, ICD-CM is an expanded classification system that adds a greater level of specificity and detail to the ICD system. 

CPT® codes

The CPT coding system was created and is maintained by the American Medical Association to track and bill medical, surgical and diagnostic services. The CPT code set is updated annually, with the 2024 set including 349 editorial changes, 230 additions, 70 revisions and Spanish language descriptors for more than 11,000 medical procedures and services.

HCPCS codes

HCPCS codes are often used by Medicare and are based on CPT codes. They’re most often used to document non-physician services and medical supplies as well as capture things like medical equipment and patient transportation.

Additional codes that may be less widely known include classifications for diagnostic groups, health functionality, drugs, dental procedures and mental disorders:

  • ICF: International Classification of Functioning, Disability and Health

  • DRG: The Diagnostic-Related Group system

  • NDC: The National Drug Code, a numeric identifier assigned to all prescription and nonprescription medications

  • CDT: Dental Procedures and Nomenclature

  • DSM-IV-TR: Diagnostic and Statistical Manual of Mental Disorders, 4th Edition, Text Revision

How are Medical Billing and Medical Coding the Same?

Medical coders and billers share an important responsibility in managing an efficient and accurate reimbursement process. There are also some similarities in medical billing vs. medical coding and the training professionals who work in this capacity receive.

The journey to becoming a biller or coder begins with education, and programs like the online Undergraduate Certificate in Medical Billing and Coding programs from DeVry can help you prepare to pursue both roles.

Medical billers and coders are both expected to pursue and maintain industry certifications from bodies such as the American Academy of Professional Coders (AAPC) and the American Health Information Management Association (AHIMA).

The skills required for both jobs are also similar. Billers and coders can both benefit from strong verbal and written communication skills, attention to detail and organizational skills, proficiency with industry-specific computer software programs, knowledge of math and a rich understanding of medical terminology.

But that is where the two roles diverge. 

Medical Coding vs. Medical Billing Differences

Medical billers and coders require different skills.

Coders typically focus on accurately translating medical information into the codes that provide the basis for accurate billing, whereas the billers focus on the financial aspect of the process in the form of managing claims and invoices that generate revenue for their facilities.

Medical billers are more likely to interface with people outside the health revenue cycle, like patients or insurance providers; therefore, billers will benefit from strong communication skills. Coders are typically only interfacing with other healthcare personnel, and while interpersonal skills are also needed, they should focus on developing a robust knowledge of medical terminology, anatomy and coding systems.

Is One Better Than the Other?

When considering your medical billing and coding career path, you might wonder whether medical billing or medical coding offer any particular advantages over each other. The simple answer is no.

Which path is the right path for you is a question that only you can answer. Which path you choose to pursue will depend on the kind of work you’re interested in doing, the environment you want to work in and many other factors.

Taking some time to evaluate where you are in your education journey, what your career goals are and what you need to do to reach them is an important step as you move forward. It will also help you identify the resources and support systems you need to help you along the way. 

Thinking About a Career in Medical Billing and Coding?

DeVry can help you get started. With our online Undergraduate Certificate in Medical Billing and Coding programs, you’ll have access to a hands-on education designed to help motivated adult learners like you gain practice with the processes and technologies that keep this essential field running.

We offer two different certificate programs to help you can choose the path that aligns best with your personal goals.

Study Medical Billing and Coding if you’re interested in pursuing a role in smaller facilities like doctor’s offices clinics, or other outpatient environments. This course of study can also help you prepare to pursue the Certified Professional Coder (CPC®) certification exam. Qualifying students will receive a voucher to cover the cost of 1 exam attempt and HIT254 - Coding Practicum and Review, our exam prep course, is included in your curriculum at no additional cost.

Or, if you’re interested in pursuing a role that focuses more on inpatient care, our Medical Billing and Coding – Health Information Coding program is a great option. Students of this certificate program will also be prepared to pursue the Certified Coding Specialist (CCS®) certification exam. We also provide a voucher to qualifying students to cover the cost of 1 exam attempt and HIT264 - CCS Review, our exam prep course, is included in your curriculum at no additional cost.

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