What is Medical Coding?

If you’ve been treated by a hospital, physician’s office or medical center, chances are you’re familiar with the concept of medical billing and coding. But, exactly what is medical coding and what does a professional in this field do?

To start, medical coding is the practice that transforms healthcare diagnoses, procedures, services and equipment into universal alphanumeric codes for medical billing purposes. Medical coders analyze information about diagnoses and procedures within medical records and other documentation – such as physician's notes, laboratory and radiologic results – then assign the appropriate codes and create a claim for submission to insurance carriers.

Medical coding also supports the operation of the healthcare system. Practitioners and facilities rely on the documentation of what's diagnosed, treated and learned about a patient's condition in order to streamline their processes and ultimately generate revenue. Proper documentation of a patient's diagnosis, test results and treatments allows practices to get reimbursement quickly and sustain a healthy cash flow.

Medical coding also helps practitioners quickly understand a patient's conditions and treatments during subsequent visits. This helps providers achieve better patient outcomes, especially in large medical practices or hospitals that serve an extensive amount of patients.

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Types of Codes Used in Medical Coding

Here are some of the common medical coding systems used in the U.S.:

ICD-10-CM (International Classification of Disease, 10th Edition, Clinically Modified)

This 69,000-code set establishes and tracks medical necessity for services. It covers conditions and disease, poisons, neoplasms, injuries, causes of injuries and treatments performed when the injuries are incurred. While some codes are highly predictable, others can be a bit more – unusual.

ICD-10-PCS (International Classification of Disease, 10th Edition, Procedural Coding System)

Hospitals use this 130,000-alphanumeric code set to describe surgical procedures performed in operating rooms, emergency departments, etc.

CPT (Current Procedure Terminology)

The American Medical Association owns and maintains this code set, which includes over 8,000 five-character alphanumeric codes. They describe services provided by physicians, paraprofessionals, therapists, etc. at both outpatient and inpatient facilities.

HCPCS Level II (Health Care Procedural Coding System, Level II)

This code set is used by Medicare, Medicaid and other providers to document procedures and bill for supplies. It contains over 7,000 alphanumeric codes used for quality measure tracking, outpatient surgery billing, academic studies, etc.

NDC (National Drug Codes)

Developed by the Federal Drug Administration (FDA), this code set tracks and reports all packages of drugs. The smart codes enable suppliers, federal agencies and providers to identify medications that are prescribed, sold and used.

APC (Ambulatory Payment Categories)

The Centers for Medicare & Medicaid Services (CMS) maintains this code set to support the Hospital Outpatient Prospective Payment System (OPPS,) which is used for outpatient services in a hospital, such as minor surgery.

Medical Coding Certifications and Educational Requirements

As you get started on your career path, you might find that many medical coding jobs may require you to obtain a Certified Coding Associate (CCA) or Certified Coding Specialist (CCS) certification, in addition to earning an undergraduate certificate or degree in this field. Here are some key steps to help you pursue the education and credentials you need for a future in medical billing and coding:

Earning a Certificate or Degree

With your high school diploma or equivalent, you can pursue an undergraduate certificate or earn an associate or bachelor’s degree. Here are some healthcare programs you may be interested in:

  • Medical Billing and Coding Undergraduate Certificate: This can be a quick path toward preparing to pursue a medical coding career. You can earn the certificate in as little as one year, as you look for employment and prepare to pursue industry recognized exams. The coursework focuses on health insurance and reimbursement, medical data classification, information processing and current procedural terminologies.

  • Healthcare Information Technology Associate Degree: This program not only covers procedural and regulatory knowledge related to the field but also helps you obtain technical skills in coding and chart management software, health data content and structure, health services and information systems, as well as insurance and reimbursement procedures.

  • Health Information Management Bachelor’s Degree: You'll learn how to implement new technologies and control costs in healthcare settings with coursework in advanced classification systems, data security, privacy management and more. You'll also be prepared to work in various healthcare settings such as hospitals, clinics, nursing homes and doctor’s groups.

  • Health Services Management Bachelor’s Degree: This program details the political, social, cultural, economic and technical influences that shape today’s healthcare system. Topics covered in this program include healthcare management, including health rights and responsibilities, healthcare policy, records management, insurance claims billing and healthcare financing.

  • Healthcare Administration Bachelor’s Degree: You'll learn how to improve the quality and efficiency of healthcare services while controlling costs. This degree program prepares you to pursue a career in healthcare policy, managed care, insurance, information systems and finance.

Industry-Recognized Certifications

After you have earned your degree or certificate, you may qualify to take one or more credentialing exams offered by the American Health Information Management Association (AHIMA). There are four options:

  • Certified Coding Associate (CCA): A nationally-recognized standard of achievement in health information management. While not required, AHIMA recommends six months of medical coding job experience before taking this exam.

  • Registered Health Information Technician (RHIT): Although no work experience is needed, you'll need at least an associate-level education in health information management to pursue this credential.

  • Certified Coding Specialist (CCS): This credential is for medical coders who want to pursue work in hospital settings. The exam tests for knowledge in terminology, disease processes and pharmacology, as well as expertise in the ICD-10-CM and CPT/HCPCS coding systems.

  • Certified Coding Specialist Physician-Based (CCS-P): This is for medical coders specializing in physician-based settings. The exam tests for mastery-level understanding and competency in the ICD-10-CM, HCPCS Level II and CPT coding systems.

Credentials such as CCA, RHIT, CCS and CCS-P need to be rectified every two years by completing continuing education units through activities such as attending AHIMA meetings, taking formal educational programs, attending teleseminars, delivering presentations, publishing academic work and conducting an independent study.

Commonly Asked Questions in Medical Coding

Is it difficult to become a medical coding professional?

It can be easier than you may think. While medical coding may sound complicated at first, with the right skillset, education and certifications you can pursue various roles across this dynamic field. At DeVry, you can earn a Medical Billing and Coding Undergraduate Certificate in just 10 courses. Better yet, our Career Services team is here to help you pursue medical coding jobs with one-on-one resume support, interview tips and job leads.

How long does it take to become a medical coder?

At DeVry, you can earn your undergraduate certificate in Medical Billing and Coding in as little as one year when you're enrolled full-time and taking courses year-round without a break. You can obtain your certificate even more quickly with qualifying transfer credits.

You can choose from two programs – our Medical Billing and Coding certificate program consists of 10 courses, totaling 34 credit hours and our Medical Billing and Coding – Health Information Coding certificate program consists of 13 courses, totaling 42 credit hours.

Where do medical coders tend to work?

Medical coders work in a variety of healthcare settings including hospitals, physician's offices, surgery centers, long-term care facilities, nursing homes, dental offices, home healthcare agencies and mental health facilities. While many coders work on-site, some employers may also support remote working options.

What are the benefits of acquiring medical coding certifications?

Earning a certification – such as the CCA or CCS – can help you to pursue a career in medical coding and billing, a fast-growing field according to the U.S. Bureau of Labor Statistics.1 In fact, some medical coding jobs require employees to be certified prior to being hired. Being certified is yet another way that you can demonstrate to employers that you are proficient in medical coding and all that it entails. If you are interested in taking an industry certification exam, consider starting by earning an undergraduate certificate in Medical Billing and Coding that includes exam preparation courses.

1Growth on a national level. Local growth will vary by location. https://www.bls.gov/ooh/healthcare/medical-records-and-health-information-technicians.htm