A Day In The Life Of A Medical Coder
When a patient comes to see a doctor, nurse, chiropractor or any number of medical care specialists, he or she may be treated by a tremendously large variety of functions, from the use of the medical professional’s time to medical instruments and medications. Each of these services, instruments or goods has a specific code that identifies the exact procedure done and its related cost. Imagine each doctor or nurse writing a paragraph of what they did to treat each patient and what they used to do this, then sending this scribble directly to the insurance provider or other responsible party for payment.
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A physician does not have the time to learn the code and cost for each of these treatments. Moreover, he or she may not even use the same exact terminology as another physician in another office in another state or region of the country, even though they are doing the exact same thing! The sheer amount of information and clutter would bring the health care industry to a grinding halt. This is where the Medical Coder comes in.
A Medical Coder is charged with the knowledge and ability to code each procedure a doctor, nurse or other health care provider performs for each patient. For instance, if a patient comes in with a broken arm, a doctor must complete a number of tasks before this patient is ready to leave the office. He will takes x-rays, repair the arm using anesthesia, caste the arm using tools and materials from the office, then prescribe additional medication to the patient. Before discharging, this doctor and his office staff have performed no less than five functions:
- 1. Take X-Rays
- 2. Administered Anesthesia
- 3. Set the Arm
- 4. Caste the Arm
- 5. Prescribed Pain Medication
Additionally, the doctor and his office must charge the patient’s insurance provider or patient for at least an additional three materials, including:
- 1. X-Rays
- 2. Anesthesia
- 3. Caste Materials
So how will the doctor’s office keep track of all this you ask? How will they know exactly what to bill the patient’s insurance company, Medicare, Medicaid or other responsible party? How will the party responsible for payment be sure they know exactly what they are paying for? How will they know that the bill they are getting refers exactly to each service performed and material used? The Medical Coder attaches a code to each line item in the bill.
So What Does This Mean?
After the doctor or other health care professional is finished with a patient, he or she will submit their notes stating exactly what was done to the Medical Coder. It is up to the Medical Coder to turn these notes, often only a scribble, into a series of codes that correlate to a list of costs. The Medical Coder will learn during their training how to look each procedure and material up quickly and efficiently in their software system in order to create a bill consisting of correct codes to be submitted to the party responsible for payment. These codes must be correct, and the Medical Coder must be able to work quickly and certify that each code attached to each note is the correct one, as there are an incredible number of possible codes for a great number of medical procedures.
A Medical Coder must set up or adhere to a system for coding each procedure and turning it into a claim. This person must first identify the type of claim this will be and who will be using the information they will code. For this reason, Medical Coders must be not only organized and diligent, but have a strong knowledge of the claims process and insurance billing procedures. Many health insurance companies run differently, and Medical Coders must understand them all. From Blue Cross and Blue Shield to Kaiser, Aetna, Allianz, Prudential and Allstate to state run health plans, low-income programs such as MEDICAID and other entitlement programs including Medicare and workers compensation (TRICARE).
Once a physician’s notes have been coded, the Coder will pass this information on to the Medical Biller, who’s responsibility it is to double check these numbers and see to it that each bill makes it to its specified recipient in a timely manner.