In short, a Coder is someone who has a thorough understanding of the ICD-9 codes, Modifiers, and CPT codes and uses this knowledge to ensure the proper application. Coders most often review the work of the physician, apply modifiers, and check for errors in CPT code bundling or ICD-9(Diagnosis Code) appendage.
For each procedure that the physician or NPP(non-physician provider performs, there is an applicable CPT code and associated Diagnosis code. The CPT code is what and the ICD-9 represents the why behind the what. Medical coding is the most difficult job in a billing office because it requires constant learning and is highly detailed oriented.
Many offices also use their coder to perform routine coding audits for the practice. These audits come in many different forms but the primary role of all audits is to ensure that all procedures billed for are properly substantiated and paid for. Many time audits are performed to ensure compliance with the documentation in the chart. These audits are performed done to safeguard the practice from owing Medicare or other payers, refunds because of inadequate documentation and over billing. Many times, audits find that physicians are under billing for most services because they do not fully understand the way to code or they are afraid of being audited.
There are different types of Coders and some are specialized in Hospitals, Private Practices or particular specialties. There a few different options when it comes to becoming certified and we have links to the different options on this site. Certification does not guarantee you a place in the coding workforce but it does place you above much of your competition.
Medical Coding as defined by the American Association of Professional Coders is:
Medical coding is a key step in the medical billing process. Every time a patient receives professional health care in a physician’s office, hospital outpatient facility or ambulatory...