Medical billing and coding jobs are in high demand, and many of them pay well and allow remote work. How do you know if this career is right for you? In this beginner’s guide, you will learn what medical billing and coding are, the credentials you need, what the work looks like, and what it costs. The details below mainly describe the United States.
What Is Medical Billing and Coding?
Training programs usually teach billing and coding together, but they are two different jobs.
Medical Coding
Medical coders review medical records and turn diagnoses, procedures, equipment, and other information into alphanumeric codes. For example, a patient with type 2 diabetes gets the ICD-10-CM diagnosis code E11.9. A patient with type 2 diabetes and end-stage renal disease may get E11.22, N18.6, and Z99.2. The match is not always one to one, because coding follows many rules and guidelines.
Organizations use medical codes for data tracking, analysis, financial planning, and mainly for billing. Coders place the codes on claim forms, which generate bills for insurance companies or sometimes for patients.
Medical Billing
Billers send claims, check that charges are correct, track denials, and follow up until payments are complete. Insurers deny claims because of coding errors or coverage problems.
Certifications and Credentials
Two main organizations certify coders: AAPC and AHIMA.
- AHIMA: Inpatient coders usually choose AHIMA credentials, such as CCS.
- AAPC: Professional fee coding, risk adjustment, and outpatient coding usually use AAPC credentials. The Certified Professional Coder (CPC) credential is widely recognized and highly valued.
Main Code Sets
- ICD-10-CM: diagnosis codes used in the United States
- ICD-10-PCS: procedure codes, mainly for hospital stays
- CPT: codes for procedures and services, such as doctor visits, surgeries, and X-rays
- HCPCS: codes for equipment, drugs, and insurance-specific items
- CDT: codes for dental procedures
- DSM-5: codes for mental health conditions
Coding systems change often. ICD-10 updates on October 1, and CPT and HCPCS update on January 1, so coders need new books or tools every year.
Work Locations and Environment
Billers and coders work in offices or from home. Employers include doctors’ offices, hospitals, insurance companies, consulting firms, and specialty groups. Working from home requires strict attention to HIPAA and patient privacy rules, and some companies set security rules for home offices.
Salary
In the United States, a certified professional coder earns a median of about $58,000 a year, and pay can rise with experience and specialty. Entry-level pay can be lower, and location affects pay. Tools such as the AAPC salary calculator show estimates for your area.
Training and Education
You do not need a two-year or four-year degree. The most important step is to prepare for a certification exam, such as the CPC from AAPC or the CCS from AHIMA. Pick training that prepares you for the exam and the job without the high cost of a degree. Many programs take about six months.
Demand and Future of Medical Coding
Automation can help with coding, but medicine is complex, and people still need to check accuracy, follow rules, and solve problems. Even in systems with government-funded insurance, coding remains necessary for data tracking, fraud prevention, and financial planning.
Costs of Becoming a Medical Coder
- Coding books and online tools every year
- AAPC membership, which costs up to about $190 a year
- Continuing education units (CEUs) and optional conferences
Some free CEU options exist.
Things to Consider
Work environments vary with management style, workload, and company culture. After a year or two of experience, changing jobs becomes easier, and more platforms now let coders work independently.