Medical assistants play a very valuable role, but they are NOT nurses !

Medical Assistant vs. Medical Coding

One of the best things about a medical assisting career is the career versatility. Medical assistants learn both front and back office procedures. Many components of clinical or administrative work can be expanded to help you further your career. Medical billing and coding is one of those components. Many medical assistants learn basic medical billing as part of their MA training program. However, a medical coding career involves so much more than what you may have learned in school. Take a closer look at how medical assisting can jump start a medical coding career.

What is Medical Coding?

Whenever a physician sees a patient, she creates a charge ticket. This is a form that allows the physician to write down what the patient’s diagnosis, and what lab tests, x-rays or diagnostics are needed. The charge ticket is then sent to the medical coder. The medical coder’s job is to assign a medical code to each diagnosis and treatment given to the patient. Each time a patient sees a physician in a professional setting, like a clinic or hospital, a charge ticket must be generated so the physician can get paid. The codes used by the medical coder are universal—meaning they are recognized by all health insurance companies. When the medical coder submits a charge ticket, or claim, to an insurance company, the insurance will know what services were provided by the codes on the claim.

  • Medical assistants learn basic coding techniques as part of the MA program. These basic skills are often appropriate for general ambulatory care coding and billing.
  • A medical assistant wishing to work for a large specialty practice, hospital or nursing home may require additional medical coding training and certification to become competent.

What Types of Codes do Coders Use?

There are many different types of medical codes. It’s a medical coder’s job to know the different codes and how to properly use them. Because medical reimbursement relies on correct coding, it is very important that the medical coder be well-trained and competent in her job.

There are three basic code types used by medical coders:

  • HCPCS codes. The Healthcare Common Procedure Coding System (HCPCS) codes are used with Medicare health insurances. HCPCS Codes are numbers given to each service a physician may provide to someone with Medicare. This includes surgical and medical services, and diagnostics. Every healthcare provider uses the same code for everything, making HCPCS codes universal for every physician anywhere in the United States.
  • CPT codes. Current Procedural Terminology, or CPT codes, is a listing of medical services a physician provides. Each service is assigned a CPT code. An insurance company then reviews the CPT code and determines how much a physician will be paid for that service. CPT codes are key codes for reimbursement from insurance companies.
  • ICD codes. International Classification of Diseases (ICD) codes are a method of tracking diseases and causes of death around the world. These codes are used for diagnostic purposes and as a way for medical professionals and scientists to track diseases and causes of death in the human population.

These codes are the foundation of medical coding practice. Formal education in medical coding provides in-depth training in each of these codes and how to use them effectively.

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Working with Insurance Companies

Medical coders work closely with insurance companies. Each claim submitted to insurance must be properly coded so a physician can be paid for services. A medical coder also needs to know how to troubleshoot a medical claim when something goes wrong. Insurance companies may deny a medical claim if the coding is wrong or does not coincide with a service the insurance company will pay for. The coder needs to know how to read the patient’s medical chart and physician notes to make sure the claim was coded correctly. Alternately, she needs to know how to adjust a claim to meet the insurance company’s guidelines if appropriate.

Some medical assistants already work with insurance companies on a daily basis. Getting pre-authorization for surgery, referrals to a medical specialist or approval for specialty care are all reasons a medical assistant may communicate with insurance company. Medical codes are likely needed to obtain authorization for any of these services. Further medical coding education will allow the medical assistant to work even more closely with insurance companies, and for more complicated or in-depth reasons.

Getting Certified

Medical coders can work in a variety of positions:

  • As a hospital outpatient or inpatient coder
  • Ambulatory care coder
  • Coding supervisor
  • Auditing specialist

Each position has its own set of requirements and knowledge and medical coding certification is often required. A medical assistant may obtain certification in medical coding by gaining further education in the field. Professional medical coders are able to become certified, depending on the type of coding they choose. The American Academy of Professional Coders (AAPC) and Board of Medical Specialty Coding (BMSC) both offer credentialing in professional coding. Your background and education as a medical assistant can be very helpful if pursuing a medical coding career or certification.

Article Written by Elizabeth Otto

Elizabeth Otto is a freelance writer specializing in medical and health articles. Otto has worked as a certified medical assistant in specialty practice since 1994 and is also a nationally registered emergency medical technician.

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