Overview of Medical Billing and Coding

Nov 1, 2024

Medical Billing and Coding Industry Overview

Introduction

  • Medical billing and coding jobs are in high demand, offer good pay, and allow for remote work.
  • Victoria, a medical coder, auditor, educator, and content creator with 10+ years of experience, provides insights into the profession.

Medical Billing vs. Medical Coding

  • Medical Coding: Involves reviewing medical records, extracting diagnoses, procedures, equipment, and translating into alphanumeric codes (e.g., ICD-10-CM codes).
  • Medical Billing: Focuses on monitoring claims, ensuring correct billing, addressing denials, and following up on payments.

Types of Medical Coding and Credentials

  • Certifying Bodies: AAPC and AHIMA are the main organizations.
  • Common Credentials: CPC (Certified Professional Coder) by AAPC is highly recommended.

Main Code Sets

  • ICD-10-CM: Diagnosis coding system used in the U.S.
  • ICD-10-PCS: Procedural coding system for inpatient hospital stays.
  • CPT (Current Procedural Terminology): Codes for procedures and services.
  • HCPCS: Codes for durable medical equipment, drug codes, etc.
  • CDT: Dental terminology codes.
  • DSM-5: Mental health condition codes.

Work Environment and Opportunities

  • Locations: Work from home, offices, hospitals, insurance companies, consulting firms.
  • Security Protocols: Strict due to HIPAA and patient privacy.
  • Remote Work: Code Health offers gig work similar to Uber or Instacart.

Salary Information

  • Median salary for a CPC is about $58,000 annually but varies with experience, specialty, and location.
  • Use AAPC's salary calculator for region-specific salary information.

Training Requirements

  • Certification is necessary; degrees are not required.
  • Training focuses on preparing for certification exams like CPC and CCS.
  • Self-training options exist but may not save significant money.

Industry Demand and Future

  • Automation is present but doesn't replace human intervention due to the complexity of medical services.
  • Ongoing need for tracking services for fraud prevention and data purposes.

Costs and Maintenance

  • There are costs for books, membership dues, and continuing education.
  • AAPC membership is approximately $190 annually.
  • Continuous education units (CEUs) are required.

Work Environment Considerations

  • Varied office environments, including potentially toxic ones.
  • Easy job switching after gaining experience.

Conclusion

  • Medical coding is in demand, with lower training costs compared to traditional degrees.
  • Offers flexibility and a promising career path despite some costs.
  • Medical Coding Masterclass: Recommended for industry training.