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What does a Medical Coder do?

Malcolm Tatum
Updated Mar 02, 2024
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As an essential role in the medical coding process, the medical coder is responsible for ensuring that all requests for diagnostics and blood work issued by a doctor contains the use of standard medical coding that is recognized by health insurance providers. Along with appearing on the requests for testing that are authorized by doctors, the same set of codes are used to encode any claims that are generated and submitted to the health insurance provider. The function of the medical coder is to ensure that the correct codes are used so that the correct testing is conducted, and the insurance company can quickly and efficiently review and process received claims.

Health information coders often function as part of the doctor’s office team. The office manager may be the person trained in the use of the codes, or this may be a responsibility that is delegated to the assistant who interacts with the various labs and medical testing facilities that the doctor chooses to use. Since the list of codes used are universal in nature, this is usually not a difficult process to employ, although it does require a talent for paying close attention to detail. Failure to apply the right medical code to the testing requested can mean a delay in accurately diagnosing the condition of the patient, as well as possibly leading to the rejection of the medical claim by the insurance company.

An individual trained as a medical coder may also work for a lab, where he or she is able to review requests for testing and make sure everything is in order before the tests are conducted. Within this capacity, the medical coder will often work closely with their counterparts in doctor’s offices, double-checking with the doctor in the event that something does not seem to be in order about the paperwork. This can help to eliminate delays in payment to the lab, so the effort is often well worth the time spent in review.

At the insurance company level, medical record coders will check to make sure the codes attached to claims are valid codes before the paperwork is submitted for further review. This is important because most insurance providers either use the same set of medical codes internally, or have a cross reference chart that ties internal codes to the set of medical codes used externally. When the coding specialist spots an invalid code, the review of the claim stops immediately, and the claim is returned to the originator.

Coder/abstractors who work for health insurance providers are charged with the task to make sure that resources are not spent working with a claim that ultimately will not be paid if the procedure cannot be verified as covered under the terms of the insured party’s policy. As a means of making sure the proper codes are used in the right context, the medical coder is an important position at several key steps in the process of providing health care administration.

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Malcolm Tatum
By Malcolm Tatum
Malcolm Tatum, a former teleconferencing industry professional, followed his passion for trivia, research, and writing to become a full-time freelance writer. He has contributed articles to a variety of print and online publications, including Practical Adult Insights, and his work has also been featured in poetry collections, devotional anthologies, and newspapers. When not writing, Malcolm enjoys collecting vinyl records, following minor league baseball, and cycling.
Discussion Comments
By anon949968 — On May 07, 2014

I went to school and got my medical coder certificate but the school State never helped me prepare for the certification.

By anon165677 — On Apr 05, 2011

I graduated medical billing and coding in 2009 and started working as a medical biller since 2009 but now I just recently got hired for Medical coder which I have the opportunity to work from home after training and they start me off at $14 per hour.

Do you think this is a good starting pay for a coder or is it a little low for a coder? Please help. I just want to find out if this is on the minimum rate of pay for coders since I was already making $14 on my previous job, which is medical billing. --Coder101

By Bhutan — On Aug 02, 2010

Brickback-I wanted to add that although a relatively new entry-level medical coder salary might be about $30,000 a year salary, he or she has to have excellent typing skills because the majority of the work will be x-ray and lab orders which will require a lot of speed.

Practicing typing skills is really important in order to gain speed.

In addition many medical coders’ seek medical coding certifications in order to gain better positions. Carol Buck wrote a training manual called CPT training which offers a step-by-step program on medical coding.

By BrickBack — On Aug 02, 2010

Icecream17- I just wanted to say that the average starting salary for a medical coder is $30,000 a year.

The general average salary for an experienced medical coder is about $45,000 a year. Many in this field seek positions working in hospitals, but after they gather several years of experience they move on to home positions where the work is more flexible.

By icecream17 — On Aug 02, 2010

I looked into becoming a medical coder, and I realized you have to be very detail oriented. You learn to provide primary diagnosis as well as other types of diagnoses for a patient's file.

Companies that generally hire medical coders include hospitals, billing companies, insurance companies, assisted living centers, doctor’s offices as well as government offices.

The ICD-9-CM and the CPT systems are medical coder courses that are learned which relate to medical billing.

The training usually lasts anywhere from eight months to one year and most schools have externships available in order to gain some practical experience in the field.

Bidwell Training Ceter offers medical coder training that lasts 38 weeks. It is a medical coder school located in Pittsburgh, Pennsylvannia.

Malcolm Tatum
Malcolm Tatum
Malcolm Tatum, a former teleconferencing industry professional, followed his passion for trivia, research, and writing...
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