What Is Medical Coding and Billing?

It is an obvious fact that the medical services industry is booming, and its development is required to proceed into what is to come. With an excess populace of 46 million Americans ages 65 and more, which is foreseen to increase twofold by 2060, and the 68% of them who experience the effects of persistent illnesses, the requirement for medical coding and billing in the medical services industry will not die down at any point in the near future.

Now let us proceed to understand what is medical coding and billing. Many practitioners and office staff who start out anew are confused about what medical coding is and what medical billing is.

The purpose of this article is to help clear the concepts of medical coding and medical billing along with the reasons why the adoption of these two concepts in your practice will bring continuous improvement and efficiency.

What is Medical Coding?

Medical coding is the process of transforming medical care and health care provision analysis, strategies, medical services, and the relevant equipment into general medical alphanumeric codes. The procedure and diagnosis codes of medical coding are taken from the documentation of medical records, for example, records of notes that the specialists and practitioners made, lab and radiologic results from prior tests conducted, and so on. Medical coding experts help guarantee the codes are applied accurately during the process of medical billing, which incorporates extracting the relevant data from existing documentation, finding out and specifying the proper codes, and making a case to be paid by insurance agencies.

Medical coding process

Medical coding is a process which occurs every single time a patient sees a health care services provider. The health care services provider surveys the problems and the medical history of that patient, makes a specialist evaluation of what is going non and how to treat the patient, and reports the visit.

That documentation is not just the patient’s continuous record, it is also the process through which a health care services provider gets his compensation which is why it is so closely linked to medical billing.

Medical coding and medical billing go hand in hand as these processes work well together and are linked for a practice to work effectively.

What is Medical Billing?

Medical billing is the cycle of submitting and following up on cases with health care coverage organizations to get payments for services delivered by a health care services provider. Medical billing transforms a medical care service into a billing receipt in a way.

The obligation of the medical billing professional in a health care office is to follow the case to guarantee the practice gets repayment for the work the practitioners perform. A skilled and experienced biller can enhance income execution for the practice making it vital for the revenue cycle management processes.

In case that you are confused if medical billing and medical coding are the same, they are not. The main duty of a medical coding consultant is to audit clinical explanations and appoint standard codes utilizing CPT, ICD-10-CM, and HCPCS Level II frameworks. Medical billing professionals, then again, measure and follow up on cases that are related to medical coverage organizations for repayment of services delivered by a health care services provider.

The medical coding consultant and medical billing professional might be the same individual in some cases or may work with one another to guarantee the payments are made appropriately to the practice.

You might wonder what is medical coding’s history and how it all started. Medical coding started from public bills of mortality posted in London in roughly the seventeenth and eighteenth century. It was through comparing these bills that specialists decided the reason for a cholera pestilence.

It is much more imperative now as the information accumulated through medical coding is utilized to improve medical care systems in general. The outcomes are submitted to payers for them to make payments, however the information that is received from the codes additionally is utilized to decide usage, oversee risk, distinguish the use of resources, assemble actuarial tables, and support general wellbeing activities.

Through the 1980s, it was typical for medical coding and billing experts to handwrite reports or use typewriters to handle protection claims. Billing and coding were tedious as most patient records that contained data, for example, test results and specialist notes were not digitized and kept in enormous envelopes.

Digital period

In the digital period, most medical service providers utilize electronic medical records to monitor patients, shedding their past dependence on paper. The medical billing and coding continue to develop and change. The change from the ICD-9 to the ICD-10 coding framework caused a ripple effect in the medical coding and billing fields.

Quick innovative development converted into an extension of the field. Because of an expanded interest for subject matter experts, medical billing and coding is one of the better-paying vocations in united medical services as well.

The medical care income stream

The medical care income stream depends on the documentation of what was found out and performed. A patient’s conclusion of the disease or problems he may have, test results, and treatment must be archived, for making payments to help with medical billing as well as to ensure improved care during future visits.

A patient’s very own past data helps them ensuing possible problems and treatments provided, and they should be effectively perceived. This is particularly significant if we consider the huge number of visits, techniques, and hospitalizations yearly in the United States which were around 36,353,946 in 2018.

The test, nonetheless, is that there are a large number of conditions, illnesses, and reasons for death. There are additionally a great many services performed by practitioners and an equivalent number of injectable medications and supplies to be followed.

Medical coding groups

Medical coding groups these for simpler references to follow. Also, in medical care, there are numerous depictions, abbreviations, and names for every sickness, system, and device. Medical coding normalizes the language and introduction of every one of these components so they can be all the more effortlessly comprehended, followed, and adjusted as per the requirements of the treatment.

This language of medical coding, ordered by the Health Information Portability and Accountability Act (HIPAA), permits clinics, health care service providers, and payers to communicate effectively and reliably. All private medical data is kept carefully and is dependent on the codes being allocated digitally. As per the Centers for Disease Control (CDC), there were over 1.4 billion patient visits in the previous year.

That is a detail that incorporates visits to doctor workplaces, medical clinic outpatient offices and trauma centers. In the case that there were only five bits of coded data per visit, which is a low estimate at that, it will still be 6 billion individual snippets of data that should be updated each year. In a framework stacked with information, medical coding considers the effective exchange of immense measures of data.

Uniform documentation

Medical coding likewise takes into account uniform documentation between medical offices. Having uniform information considers effective exploration and investigation, which government and health care organizations use to follow medical patterns substantially more effectively. What medical coding also permits organizations is to take a look at the viability of treatment in their office.

This is particularly critical to enormous medical offices like emergency clinics. Like government organizations following, state, the rate of a specific sickness, medical offices can follow the productivity of their practice by investigating.

Advantages of Medical Coding:

  • A visible reduction in accounts receivable days.

  • Evasion of expensive back billing

  • Cleaner claims and less refusals

  • Over 95% precision

  • Capacity to create client specific reports

Advantages of Medical Billing:

  • Expanded income generation.

  • Quicker handling of cases which brings about more revenues

  • More opportunity to zero in on center capabilities and increase productivity

  • Diminished practice overhead expenses by having the option to enlist less workers

  • Capacity to evade arrangements with payers and insurance agencies

  • Up-to 96% net collection rate

Medical coding consultant

A handy medical coding consultant helps medical care clinics, insurance payers, and current and potential patients to explore the complexities of the numerous laws, guidelines, and rules identified with the business side of medical care.

Another appealing part of a medical coding consultant’s job is that it offers challenges and open doors for self-improvement without long periods of tutoring or training. Proficient medical coding consultants invest a large portion of their energy inspecting medical records to find out codes and guarantee that the medical care service providers they work for are appropriately repaid for their services. The role of medical coding consultants is not a simple one. They should continuously review the specialist’s notes in order to decide precisely what services the patient received.

Furthermore, the medical coding consultant should also comprehend private payer arrangements and government guidelines for exact and consistent coding and billing practices. Similarly, it crucial for a practice to have experts for medical billing, billing errors result in overcharges of 26% on average.

Experienced medical billing professionals

Experienced medical billing professionals have broad information on complex case accommodation processes. Medical billing experts ensure that their staff go through thorough proper training and effectively complete the necessary tasks. While at work, these medical billing experts guarantee accuracy for your clinic.

They decrease the quantity of dismissed claims as well as audit and edit claims for mistakes before the case is sent off to the payer. These are the reasons why you need experts for your medical billing processing cycles. When everything was done on paper, the error rate of medical billing was up to 80% and it has reduced exponentially since then.


Medical billing and coding are constantly changing and helping in the improvement of the health care systems, it is important to keep yourself updated on these changes and benefit with the first mover’s advantage.