What does a Medical Coder do?

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.