How Medical Billing Differs from Medical Coding

The Medical Billing and the coding require two different sets of expertise. So, normally two different individuals perform these two different functions.  The Medical billing experts can do both the coding and billing practices.

Medical coding is the process of translating medical procedures and services into a regular code of standardization. The two sets of codes that are used in the healthcare system are diagnostic (ICD) codes and procedural (CPT) codes.

The codes that describe the medical conditions are Diagnostic codes. World Health Organization (WHO) made a list of medical classifications in the International Statistical Classification of Diseases and Related Health Problems (ICD). The most popular codes have been branded as ICD-10-CM.

The ICD codes are ascertained by the Coders after reviewing medical records and determining the specific health condition diagnosed by a healthcare provider. Every disease has its code. A non-fatal gastric ulcer with no sign of hemorrhage is coded as K25.9

Primarily the ICD codes are meant for numerical and research principles. But they help the insurers to understand the reason for being treated. When an insurer is billed for treating a nonfatal gastric ulcer, an insurer finds an ICD billing code that reflects the diagnostic condition. In case, there found any disparity between diagnostic and procedure of treatment, the insurer might reject the medical billing.

Coders find out the right CPT code after the assessment of the medical records. Then they identify services that a patient received. Each insurer has agreed to pay a fixed amount of money for each procedure or service identified by a CPT code. Some coding modifiers, for example, specify that the procedure took an extended period to perform, it triggers an additional payment.

Medical Billing

The medical billers after getting diagnostic and procedural codes prepare a bill to submit to both the patients and insurers. Medical billing experts are responsible for the reimbursement by following up with the insurers and agencies. If billing is not granted, they correct the errors that are responsible for the rejection.

So the medical billers come first to set up a link between doctors and patients or the insurer.  The billers explain to the insurer the reasons for denials of money claimed. But, when the bill is paid in part and the patient remains responsible to pay a fraction of the entire balance, the medical biller reacts to the patient’s questions concerning the responsibility of the patient for the payment.

Medical billing personnel is primarily responsible to maintain the income of medical practice. They may supervise the preparation of invoices and account payments.  The billers might have discussed the payment plans with the patients. They may work together with medical practice owners or their lawyers if and when they decide if the medical bills need to be placed for collection.

So, in medical terminology, both medical coders and medical billers are well-known. Medical coders may have more experience and training to help billers to comprehend and interpret the information included in the medical records. Both the medical biller and coder are expected to work perfectly to avoid any medical billing challenges.