Table of Contents for the

Medical Coding Career Guide

Introduction

Medical coders document the diagnoses given to a patient as well as the procedures and equipment used to treat them. They then take this list and enter it in a coded form, which makes record-keeping easy and consistent across all healthcare facilities. Medical coding also helps remove ambiguity from diagnoses, and removes the risk of illegible writing or changes in terminology that might cause problems for patients later on. It also makes it easy for public health experts to anonymously gather data on the location and frequency of illnesses and injuries. They can simply search for the code of a disease rather than digging through archived patient records.

A closely related career is medical billing, so the jobs of billing and coding are often performed by the same person. When a patient undergoes a medical procedure or visit, billers handle payment for that service. Insurance companies and programs like Medicare or Medicaid establish guidelines based on what services they will pay for, and at what rate. By converting the services, medications, and equipment used for a patient's treatment into standard reference codes, medical billers track how much patients owe after deducting the amount that their insurance or program covers.

As a medical biller and coder, you can expect to work with medical records and communicate with doctors, nurses, and other caregivers, as well as with billing agencies such as Medicare or private insurance companies. You will need to be detail-oriented, comfortable working with electronic data entry systems, and good at communicating with billing and insurance groups.

The job outlook for medical coders is excellent. The Bureau of Labor Statistics (BLS) predicts 37,700 new positions for medical coders by the year 2020, not including openings created by older medical coders retiring. Medical coders earn, on average, $32,350 per year, and find employment primarily in hospitals or physicians' offices, although openings exist in other locations, such as nursing care facilities and home health care centers.

Chapter One

Chapter 1 introduces you to the ins and outs of medical coding and billing. Medical coding uses short codes to simply and accurately record procedures and diagnosis. For instance, under one system, the code "JO530" stands for an injection of penicillin. You will learn more details about medical coding systems, legislation that has strongly affected the field such as the Health Information Portability and Accounting Act (HIPAA), and information on the medical coding job market. You will also get information on your potential income and clarification of the sometimes-confusing boundaries between medical coding, billing and transcription, all of which can be considered part of the same field.

Ch 1.1: What is Medical Coding

Here, you will learn about the fundamentals of medical coding systems. You will be introduced to the Current Procedure Terminology (CPT) codes managed by the American Medical Association (AMA), the Healthcare Common Procedure Coding System (HCPCS) created to service Medicare/Medicaid billing, and the ICD-9 and ICD-10 coding systems created by the World Health Organization (WHO). ICD-9 is an older system, and the health care industry is in the process of switching over to the much more specific and organized ICD-10. However, the need to learn an entirely new system is a major factor driving early retirements among medical coders.

Ch 1.2: HIPAA - Health Information Portability and Accounting Act

HIPAA is a law that requires certain measures to be taken in order to protect patients' records. HIPAA is a vital part of the medical coding field, and you will need to become familiar with it to succeed. In brief, you must let patients see their records within thirty days of a request, notify patients on how their medical records may be used (for instance, sharing with insurance companies), and you cannot use medical information for marketing without explicit patient permission. You will also find resources from the U.S. government and the American Medical Association that elaborate in greater detail current law and developments in HIPAA enforcement.

Ch 1.3: Where do medical coders work?

In this section, you will learn about the places where medical coders work. As a medical coder, part-time work is available, but you should expect a full-time position. Some of the locations that hire medical coders, such as hospitals and round-the-clock nursing facilities, require medical coders that are available on weekend and night shifts. Other locations, like outpatient care centers and private physicians' offices, work a more typical 9-to-5 schedule. There are also non-traditional locations where medical coders may work, such as federal, state and local government facilities, health insurance companies, and law firms. You might also work at home, either for a company or on your own.

Ch 1.4: Job Market

As a medical coder, you will be entering a field with great prospects for growth. Healthcare information technology is, in general, on the rise, and medical coders are one of the key professions making it happen. Due to both growth in the number and kind of procedures, and how closely those procedures are being scrutinized by health insurance companies and other firms, the demand for medical coders keeps increasing. Even places you might not think need medical coders, such as law firms and small physician's offices, are part of this increasing demand.

Ch 1.5: How much does a medical coder earn?

Based on a professional survey of the members of the American Academy of Professional Coders, the average certified medical coder earns $39,000 per year. Wages are also on the increase, with higher degrees of experience leading to paydays approaching $45,000 per year, and with every sign pointing to further increases as demand for medical coders gets higher. You can find resources for determining the salaries in this field in your present location, and check what you could earn with your present experience after further education. One thing to keep in mind: the ICD-10 coding system is the wave of the future, and you should be sure to gain expertise in it.

Ch 1.6: What is the difference between medical coding, billing, and transcription?

Medical coding, billing, and transcription are three unrelated skills that often get lumped together. Read this section to get the story straight. Briefly, medical billers focus on handling the processing of payments. Medical coders, on the other hand, simply record the data needed for billing and recordkeeping. Medical transcription is the process of taking medical records written in longhand by doctors, psychologists and other medical professionals and encoding the diagnoses and treatments in coding language. If you're interested in starting your own medical coding business, you should be certain to study billing closely, with transcription also being a lucrative possibility.

Chapter Two

Medical coding as a profession does not require advanced study, but this does not mean it lacks challenges. This chapter will introduce the pros and cons of pursuing medical coding and billing as a career in a clear and unbiased way, laying out all of the details of the profession so that you can make an informed decision about whether or not to pursue a career in this field. You will also learn about some of the unusual aspects of medical coding, such as the role of medical coders in insurance fraud investigation, and the many networking opportunities available to medical coders.

Ch 2.1: Advantages to Medical Coding

This section discusses the advantages of pursuing medical coding and billing as a career. First, the field is growing, with tens of thousands of new positions expected over the next decade. A wave of retiring veteran coders getting ahead of the transition to ICD-10 ensures there will be plenty of room for promotion. The nature of the field means you will always be learning, and it is also possible to specialize in a particular aspect of coding, such as cardiology or oncology. You will also have plenty of opportunities to network with medical professionals, and in some cases you may be able to work from home.

Ch 2.2: Disadvantages to Medical Coding

Medical coding has its disadvantages as a career, however, and this section introduces you to them and ways to cope with them. You will learn about how to get the work experience you need to get a good job through internship, entry-level positions and, if necessary, relocation. There are other downsides to medical coding as a health profession. While you will help many people and even save lives, you will very rarely work with patients directly (although this may seem like an advantage to some). Many of the tasks you will perform will also be repetitive or stressful, especially if you have difficulty using a computer for long periods of time.

Chapter Three

Medical coding is a complex skill requiring a great deal of specific knowledge and training before you can even get started. The consequences for error can be huge, although fortunately most mistakes can easily be caught and corrected. However, you will be working with medical records and diagnoses that can record patients' allergies to medication and other life-saving information. Therefore, you need a firm grounding in education. This section will introduce you to the topics you will study, as well as what you need to know to avoid scams and deceptive schools which will offer you an insufficient education for your medical coding career.

Ch 3.1: Education and Medical Coding

Medical coding is complicated, and this section guides you through what you need to look for in your coursework. You must become familiar with CPT, HCPCS and ICD-10 (ICD-9 can also still be helpful), as well as anatomy and physiology, medical terminology, and pharmacology. You will likely also take courses on healthcare law and ethics, detecting insurance abuse and fraud, and specialized coding used for particular specialties, such as cardiology and radiology. If you intend to pursue a management career or operate your own business, you will also find guidance on learning about management and business while you learn to code.

Ch 3.2: BEWARE of scams

Medical coding is a field in high demand, and it is possible to perform the work by telecommuting in many cases. Unfortunately, this makes the field ripe for scams. We give you advice on how to be sure your school gives you real academic training that prepares you for certification. You can find out how to research a school or program before you commit to it, check out a guide to scams and frauds in general and how to avoid them, and read tips on how to check if an opportunity really is valid, as many of the offers are simply too good to be true.

Chapter Four

This chapter introduces you to the professional side of medical coding. Like many skilled trades, medical coders have their own societies and organizations who provide professional opportunities for networking and training, as well as offering certification programs which help you demonstrate to employers that you learned genuine and useful coding skills. We introduce you to the American Health Information Management Association and the American Academy of Professional Coding, both of which offer certification programs for medical coding as well as transcription and billing work. You can also opt to specialize and earn certification in a particular field, like gynecology, surgery, or cardiology.

Ch 4.1: Certification - The American Health Information Management Association

The American Health Information Management Association represents many professions connected with information technology in medical care, including medical coders. You can find out more about the advantages of joining AHIMA, as well as the certification programs they offer. We will also tell you about the professional roles coders with AHIMA certifications fill, and the costs of their various programs. AHIMA examinations usually involve a combination of multiple choice questions and case studies, where you must code an example case correctly. In addition, you will need to take seminars and other continuing education units to keep your certification, which AHIMA organizes for its members.

Ch 4.2: Certification - American Academy of Professional Coders

The American Academy of Professional Coders (AAPC) focuses more strongly on providing specialty credentials. They offer certification in general purpose coding as well as certifications focused on hospital coding, payer-billing coding, and specialty examinations for particular medical fields for a total of eighteen at this time. You can explore details about AAPC's certification programs as well as requirements for continuing education, cost of examinations, and different ways which you can earn continuing education credits, such as publishing an article or paper or attending your local AAPC chapter's meetings. AAPC does require membership for examinations, but offers it at a discounted student rate.

Ch 4.3: Preparing for your Exam

Being certified as a professional medical coder requires you to take an examination. These are usually conducted privately, and many of your courses may be designed with the content and requirements of the examination in mind. AAPC and AHIMA even offer courses specifically tailored to their own educational requirements. You will find out more about which examination you should sit for, and discover resources to help you find more information on topics such as what fees you will need to pay and how soon you will be able to retake the exam if you should receive a failing mark.

Chapter Five

One of the great attractions of medical coding is the promise that you will be able to work from home. Of course, despite the promises of many scams, this is not always feasible, but there is a very real section of the medical coding profession that does offer opportunities for telecommuting. This chapter introduces you to how you can do medical coding work from home, either partially or as your entire workload. Find advice on how to gain the right experience, ask the right questions in interviews, and keep in touch with others working in the field to find work-at-home opportunities.

Ch 5.1: Finding an At Home Medical Coding Job

Learn the requirements of attaining a position where you can perform medical coding at home. Typically, this will involve using a home computer to access your employer's network systems, where you will find patient information to encode and systems for uploading your work to the system's database. Learn about how working from home must be structured to conform with HIPAA, how to earn the experience which many home medical coding jobs require, and get tips on how to work with your fellow students, instructors and career counselors to get the job that is best suited to you.

Chapter Six

Learn the requirements of attaining a position where you can perform medical coding at home. Typically, this will involve using a home computer to access your employer's network systems, where you will find patient information to encode and systems for uploading your work to the system's database. Learn about how working from home must be structured to conform with HIPAA, how to earn the experience which many home medical coding jobs require, and get tips on how to work with your fellow students, instructors and career counselors to get the job that is best suited to you.

Ch 6.1: Starting Your Own Medical Coding Business

Developing your own business is a major challenge, and reading through this section will help you plan how to reach your goals. You will learn about how to earn certification that applies to this particular form of medical coding and the importance of keeping it current, as well as advice on how much time you should spend gaining experience as a medical coding and billing specialist before you start your own business. You also will need an even greater understanding of HIPAA's provisions and requirements for when you work alone, as violating the specifics of the act could ruin your business in no time at all.

Chapter Seven

Reading the previous chapters should have given you a good idea of what you will be getting into when you commit to a career in medical billing and coding. You will have shed your illusions and misinformation with good, clear, concise knowledge, but you may still have questions that a site of this nature cannot fully answer. As such, we have provided you with a resource page, which collects both the links we have shared throughout the guide and new resources, as well as suggestions for workbooks, magazines and software for you to obtain further education and career opportunities in medical billing.

Ch 7.1: Conclusion and Resource List

This resource list comes with all of our best wishes for your future career, but more practically, you will find links to professional organizations for medical coders and medical workers in general, special-interest message boards for medical coders, access to study materials, and a guide to some of the best books you can buy from AHIMA or other online sources. You should also consider joining a mailing list or subscribing to a journal for medical coders, either for general industry news or information focusing on your specialty. You can also brush up on your HIPAA compliance, make use of professional software, and read up on medical billing and transcription.