Introduction

Like any other business or industry, healthcare sector too heavily depends on the revenue generation in order to carry out its operational expenses and to meet office staff cost. So, financial growth is imperative for any healthcare organization and practice. There are multiple processes which are critical to ensure decent growth and stability in the finance of the practices. If the execution of these critical processes are to be taken lightly, they have the ability to haunt the practices and healthcare organizations.

Medical Coding

What actually medical coding is and what is its significance in the healthcare business?
Simply put, medical coding is the decoding or transformation of healthcare related diagnosis, procedures, medical services given and equipment used during the treatment into alphanumeric codes. The diagnosis and procedure codes are extracted form medical record documentation which physicians inscribed in their medical notes during the service given to the patient and also laboratory and radiologic results.
Needless to say, healthcare provider should be extra vigilant while documenting the services, symptoms and treatments given to the patients. The documentation should be legible enough that the transformation of medical information into codes can be easily and correctly carried out. The medical coding started whenever the patient enters into the office of a healthcare provider. The more the clearer and legible documentation is, the easier will be the coding process be.
Medical coding procedure which translates the medical practice’s documentation into standardized codes tells the payer following:
• Patient’s diagnosis
• Treatments given to patients
• Services provided to patients
• Unusual circumstances or medical conditions that affected the treatment or service. Why medical Coding is needed

Medical Coding is paramount to any healthcare business. It plays a crucial role in the process of clean claim submission and determines the revenue outcome for the practices. If done incorrectly, the claims get simply denied disrupting the cash flow cycle and thus crippling the practice financially. However, it is easier said than being done. There are literally hundreds and thousands of medical conditions, diseases and injuries. Similarly, there are hundreds and thousands of services given by healthcare providers. Medical coding should be able to see beyond these clutters and helps making reporting and tracking easy.
Not only that but it is also critical to patient care. It directly deals with patient’s demographic assessment, treatment outcome and the study of diseases. It tends to delve deep into patient data, diagnosis, treatment, medications and procedures. If this information is transformed incorrectly, it will hurt both the practice and the patient.

Medical Coders

Medical coders decode healthcare diagnosis, medical procedures, services and equipment used by healthcare providers into alphanumeric codes. The decoding information is taken from physicians and doctors prescribed transcriptions, laboratory test results and medical documentation. Medical coder should be well-versed to ensure that codes are applied correctly by abstracting the information from medical notes and documents.
Therefore, medical coders are an integral part of healthcare industry and are vital in the process of efficient revenue generation. An experienced and skillful coder is a great help to healthcare providers, facilities, patients and payers navigating through the complexities and mazes of laws, regulations and guidelines related to the business.
So, a medical coding specialist plays a significant role in decoding physician notes which have a key information regarding treatments and services into alphanumeric codes. These codes also have the medical terminologies that are shared between healthcare professionals and insurance payers in order to maximize the reimbursements.
Medical Coders normally review medical records to assign codes and make sure that healthcare providers are properly and efficiently reimbursed for their services. In order to perform their duties more efficiently and carefully, medical coders need to read physician notes as to determine the exact nature of the services and treatments patient has received. Moreover, a professional coder should also have a full grasp over payer policies and government rules and regulations for accurate and efficient coding.

Essential Qualities of a Medical Coder

Following are the must have qualities medical coders need to have:

Analytical Skills

There are times when the information may not be straight forward or easy to extract. Medical coders should always be vigilant enough to be able to look for the details and analyze the documentation in order to transform the medical information into standardized codes. This will help in accurate submission of the claims and the practices will be able to get reimbursed timely.


Attention to Detail
This trait is a must have for any professional medical coder. There are thousands of alphanumeric codes. Finding and assigning the most appropriate code is the key but could be difficult and tricky sometimes. If code assigning is not right, it can impede cash inflow for the practice. Medical coders should be able to swap in between various documents, prescriptions and reports without compromising quality.


Integrity Medical coders deal with the patients. The services, treatments and all kinds of diagnosis are in play and raise the stakes inadvertently, so medical coders should be committed to keep the sanctity of this profession above all by protecting patient’s privacy and confidentiality.

Technical Skills

Medical coders should be comfortable with the billing soft wares and required technologies in order to be able to execute their duties efficiently.

Understanding of the Medical Field

Medical coders must have in-depth knowledge of anatomy and physiology of the human body. They should have a basic grasp over the functions and conditions involving humans and should also be able to differentiate between different medical terminologies.

Sound Communication Skill

Communicating and interacting with doctors, surgeons, nurses, medical billers and front office staff to discuss patient’s record falls under the job responsibility of a medical coder. Therefore, it is important for medical coders to master complex medical terms and jargons to better understand and excel in their job responsibility.

Essentials for becoming a medical Coder

There is no mandatory requirement or specific degree to be a professional medical coder. It is crucial to have a comprehensive amount of understanding of medical field. Other than this there are numerous short courses and certifications such as healthcare administration course to hone the skills of people who want to enter in this field.

Medical Coding Modifiers

Medical Coding modifier incorporates two characters either letters or numbers which are used additionally with the CPT or HCPCS codes to indicate any service which needs to be described separately and has not occurred exactly as described by the already available codes. A modifier also provides details which are not included in code descriptors for example anatomic location of the procedure. There are many modifiers but here are some of the most used modifiers. Modifier 24: Unrelated E/M service by the same healthcare professional during post-operative period. Modifier 25: The healthcare provider gave extra service on the spot. Modifier 26: This modifier includes both professional and technical component to the procedure. Modifier 27: This modifier relates to the multiple visits on the same day by the same or different physician. Modifier 51: Multiple procedures by the same professional at the same session. Modifier 59: Linked services by the medical provider. Modifier 76: Separate sessions but by the same medical provider.