Medical Coding vs. Medical Billing: What’s the Difference?

Although closely related, medical coding and medical billing are two distinct processes within the healthcare revenue cycle. Both are essential for healthcare providers to receive payment for their services.

1. Medical Coding

What it is:

Medical coding is the process of translating healthcare diagnoses, procedures, services, and equipment into standardized codes.

Key points:

Uses standardized code sets like ICD-10, CPT, and HCPCS.

Each code corresponds to a specific diagnosis or procedure.

Coders review doctor’s notes, lab results, and clinical documentation to assign accurate codes.

Example:

If a patient visits the doctor for bronchitis, the coder would assign the appropriate ICD-10 code (e.g., J20.9) for acute bronchitis.

Goal:

Ensure the medical record is coded accurately for billing, insurance claims, and recordkeeping.

2. Medical Billing

What it is:

Medical billing is the process of submitting and following up on claims with health insurance companies to receive payment for services provided by a healthcare provider.

Key points:

Uses the codes provided by medical coders.

Prepares and submits claims to insurance companies.

Handles payment posting, claim denials, and patient billing.

Example:

Once the code for bronchitis is assigned, the medical biller uses that information to create an insurance claim and send it to the patient’s insurer for reimbursement.

Goal:

Ensure the healthcare provider is paid properly and promptly for services rendered.

Key Differences at a Glance

Aspect Medical Coding Medical Billing

Purpose Translate services into standardized codes Submit claims and collect payments

Focus Clinical documentation and accuracy Insurance claims and payment processing

Tools Used ICD-10, CPT, HCPCS codebooks Billing software, EHR, insurance portals

Work Begins After patient visit After coding is completed

Requires Knowledge of Anatomy, medical terminology, coding guidelines Insurance policies, billing regulations

Conclusion

Medical coders focus on what was done during the patient visit.

Medical billers focus on how to get paid for what was done.

Both roles work together to ensure the healthcare provider is reimbursed correctly and efficiently.

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