Types of Medical Coding Jobs

Within healthcare, multiple job opportunities exist with the majority in great need for qualified workers. Because there is an increasing number of people needing quality medical care, this particular sector is growing faster than expected. Some of the jobs in highest demand are those involving actual medical professionals who provide patient care while others are workers behind the scenes handling patient accounts, running diagnostics, and so on. For this group of people, skilled employees are needed most for medical coding jobs.

As far as medical coding jobs, there are actually several different career opportunities, each being slightly unique and offering a somewhat different pay scale. Because of the huge need in this area, we wanted to provide information specific to options for medical coding jobs that a person might consider. Keep in mind, all of these jobs offer stability, good pay, and opportunity for advancement within the healthcare sector.

Job Information

To start with, it is important to know that while there are many different medical coding jobs from which a person could choose, they do not all fall under this category or have titles that would reflect as being associated with medical billing. Therefore, it would be more beneficial to look at jobs that involve the same type of work opposed to jobs being titled as “medical coding”. Overall, work for jobs such as these includes billing for services provided to patients, as well as medical supplies and procedures.

These jobs entail using a numeric coding system which would be applied to diseases, conditions, treatments, diagnosis, medications, treatment plans, and continued care among other things for each patient seen. With the information for a patient file being properly coded, the process of filing insurance forms for payment or reimbursement would be possible. Therefore, while coding is a large part of these jobs, billing is also involved which is why jobs are sometimes referred to as medical billing and coding.

Although some medical coding jobs are entry level positions, the work requires a skilled professional. Qualifications to work in the various jobs would vary to some degree but they would all require something specific to include the following:

• Experience in billing and coding
• Experience working in a healthcare environment
• Specialized knowledge
• Experience with insurance or medical billing and coding procedures

Now, there are some companies that will hire a person for medical coding jobs who has not worked in a healthcare environment but for the most part, this would be a huge benefit for the facility and doctor but also the individual hired to do the work. 

Medical Coding Arenas

As mentioned, several different options exist for medical coding to include actual jobs and duties, as well as areas of expertise as shown below. Depending on the individual’s experience, training, and education, as well as the hiring doctor or facility, the area in which a person works could be just one or several.

Medical – The areas that commonly need medical coding experts includes dentistry, cancer care, and pediatrics
Coding System – In this case, areas would include a doctor’s office, nursing home or assisted living facility, or surgical center
Insurance – Along with private and public insurance companies, the individual would likely handle insurance claims with Medicaid and Medicare
Patient – This would include patients on an inpatient or outpatient basis, as well as those receiving emergency care

Job Options

Regarding actual medical coding jobs, the following are a few examples where dedicated and skilled workers are always needed.

Medical Billing Clerk – Primary responsibilities for this job involves maintaining patient records specific to services, goods, and procedures provided for a specific healthcare facility. Invoices would be generated and bills printed for payment from patients, as well as insurance providers, merchants, and various service providers. Because the person in this role would have direct contact with patients and professionals, great communication and customer service would be mandated along with billing and medical coding ability.

Medical Coding Specialist – For this job, medical documents would be reviews and key information about a patient’s condition extracted. That information would then be translated using numerical codes into a diagnostic and procedural system that allows insurance claims to be filed while following regulations set by the federal government.

Clinical Data Specialist – This is the last of the medical coding jobs we wanted to mention, which includes duties of reviewing, editing, and making corrections to data that the internal computer systems generated. With this, accuracy and compliance of information for medical billing purposes could be validated specifically for Medicaid and Medicare.

GEMs FAQs

The Centers for Medicare & Medicaid Services (CMS) and the Centers for Disease Control and Prevention (CDC) created the national version of the General Equivalence Mappings (GEM) to ensure that consistency in national data is maintained. They have made a commitment to update the GEMs annually along with the updates to International Classification of Diseases, 10th Edition, Clinical Modification (ICD-10-CM) and Procedure Coding System (PCS) during the transition period prior to ICD-10 implementation. CMS and CDC will maintain the GEMs for at least three years beyond October 1, 2013, which is the compliance date for implementation of ICD-10 for all covered entities.

1. Are the General Equivalence Mappings a Substitute for Learning to Use the ICD-10-CM and ICD-10-PCS?
The GEMs are not a substitute for learning how to use the ICD-10-CM and ICD-10-PCS. Providers’ coding staff will assign codes describing the patients’ encounters from the ICD-10-CM and ICD-10-PCS code books or encoder systems. In coding individual claims, it will be more efficient and accurate to work from the medical record documentation and then select the appropriate code(s) from the coding book or encoder system. The GEMs are a tool to assist with converting larger International Classification of Diseases, 9th Edition, Clinical Modification (ICD-9-CM) databases to ICD-10-CM and ICD-10-PCS.

2. Who Can Use the General Equivalence Mappings?
The GEMs can be used by anyone who wants to convert coded data. Possible users of the GEMs include the following:

• All payers;
• All providers;
• Medical researchers;
• Informatics professionals; 
• Coding professionals—to convert large data sets;
• Software vendors—to use within their own products;
• Organizations—to make mappings that suit their internal purposes or that are based on their own historical data; and 
• Others who use coded data.

3. What are the General Equivalence Mappings?
The GEMs are a tool that can be used to convert data from ICD-9-CM to ICD-10-CM and PCS and vice versa. Mapping from ICD-10-CM and PCS codes back to ICD-9-CM codes is referred to as backward mapping. Mapping from ICD-9-CM codes to ICD-10-CM and PCS codes is referred to as forward mapping. The GEMs are a comprehensive translation dictionary that can be used to accurately and effectively translate any ICD-9-CM-based data, including data for:

• Tracking quality; 
• Recording morbidity/mortality;
• Calculating reimbursement; or
• Converting any ICD-9-CM-based application to ICD-10-CM/PCS.

The GEMs are complete in their description of all the mapping possibilities as well as when there are new concepts in ICD-10 that are not found in ICD-9-CM. All ICD-9-CM codes and all ICD-10-CM/PCS codes are included in the collective GEMs:

• All ICD-10-CM codes are in the ICD-10-CM to ICD-9-CM GEM; 
• All ICD-9-CM Diagnosis Codes are in the ICD-9-CM to ICD-10-CM GEM;
• All ICD-10-PCS codes are in the ICD-10-PCS to ICD-9-CM GEM; and
• All ICD-9-CM Procedure Codes are in the ICD-9-CM to ICD-10-PCS GEM.

4. How Have the General Equivalence Mappings Been Used to Date?
To date, the GEMs have been used to:

• Translate ICD-9-CM codes in the Official ICD-9-CM Coding Guidelines to aid in producing the Official ICD-10-CM Coding Guidelines; 
• Convert version 26.0 of Medicare Severity Diagnosis Related Groups from an ICD-9-CM-based application to an ICD-10-CM/PCS-based application;
• Convert the Medicare Code Editor to a native ICD-10-CM/PCS-based application; and
• Produce a purpose-built ICD-10-CM/PCS to ICD-9-CM crosswalk for reimbursement called the ICD-10 Reimbursement Mappings.

5. What are the Reimbursement Mappings?
The Reimbursement Mappings were developed by CMS in response to non-Medicare industry requests for a “standard one-to-one reimbursement crosswalk,” which is a temporary mechanism for mapping ICD-10-CM/PCS codes submitted on or after October 1, 2013 back to “reimbursement equivalent” ICD-9-CM codes. In order to develop the Reimbursement Mappings, CMS used the GEMs as a starting point by selecting the best ICD-9-CM code that maps to each ICD-10 code based on Medicare data. The Reimbursement Mappings identify the best matching ICD-9-CM code that can be used for reimbursement purposes for each ICD-10 code. All ICD-10-CM/PCS codes are in the Reimbursement Mappings; however, all ICD-9-CM codes are not in the Reimbursement Mappings. Where an ICD-10-CM/PCS code translates to more than one ICD-9-CM code, a single choice is required to create a functioning crosswalk. Inpatient hospital frequency data was used to aid in choosing a final ICD-9-CM translation in the crosswalk. If needed, the Reimbursement Mappings may be used to process ICD-10-CM/PCS-based claims received on or after October 1, 2013, with a legacy ICD-9-CM-based system as part of a planned transition period, until systems and processes are developed to process ICD-10-CM/PCS-based claims directly. The Reimbursement Mappings consist of two crosswalks:

• ICD-10-CM to ICD-9-CM for Diagnosis Codes; and
• ICD-10-PCS to ICD-9-CM for Procedure Codes.

CMS is not using the ICD-10 Reimbursement Mappings for any purpose. We are converting our systems and applications to accept ICD-10-CM/PCS codes directly.


6. Is There a One-to-One Match Between ICD-9-CM and ICD-10?
No, there is not a one-to-one match between ICD-9-CM and ICD-10, for which there are a
variety of reasons including:

• There are new concepts in ICD-10 that are not present in ICD-9-CM;
• For a small number of codes, there is no matching code in the GEMs;
• There may be multiple ICD-9-CM codes for a single ICD-10 code; and 
• There may be multiple ICD-10 codes for a single ICD-9-CM code.

General Equivalence Mappings

In healthcare, diagnosis and procedure codes and their attached descriptions are the currency for many critical data transactions. Healthcare organizations rely heavily on coded data to govern reimbursement, monitor the health of the population, track trends in disease and treatment, and optimize the delivery of healthcare in the US.

The possible implementation of the ICD-10 code set is a historic opportunity to upgrade the quality of healthcare data, but like everything worth having, it comes at a cost. One cost is mapping between the old and new code sets.

A recurring theme in the ongoing ICD-10 implementation debate has been the need for a crosswalk between the old and new code sets to help the industry make the transition. The lack of an “official” mapping between ICD-9-CM and ICD-10-CM/-PCS has long been seen as a major challenge to ICD-10 implementation. The General Equivalence Mappings (GEMs) are an attempt to meet that challenge.

What Are GEMs?

The GEMs are the product of a coordinated effort spanning several years and involving the National Center for Health Statistics (NCHS), the Centers for Medicare and Medicaid Services (CMS), AHIMA, the American Hospital Association, and 3M Health Information Systems. The GEM files are a public domain reference mapping designed to give all sectors of the healthcare industry that use coded data a tool to convert and test systems, link data in long-term clinical studies, develop application-specific mappings, and analyze data collected during the transition period and beyond.

It would be impossible to produce a “one size fits all” set of mappings because a mapping is heavily dependent on its purpose. A map for reimbursement uses different rules and contains different entries than a map for research.

The GEMs are more than simple crosswalks. They cannot be used in a legacy system in unaltered form to get from a code in one set to a code in the other. A clear one-to-one correspondence between an I-9 or I-10 code is the exception rather than the rule.

It is useful to think of GEMs as two-way translation dictionaries for diagnosis and procedure codes from which crosswalks can be made for specific purposes. They elucidate the differences between the code sets and assist users in making informed decisions about how to link the codes in a way that meets their needs.

While ICD-9-CM diagnosis codes and ICD-9-CM procedure codes are maintained by two different government entities, the GEMs were developed separately but collaboratively to maintain consistency insofar as possible. The resulting files can be merged seamlessly as needed—subsets extracted, analyzed, and applied—without taking extra steps to make them compatible.

Medical Billing and Coding Certification

Professional medical billing and coding certification is a designation earned by an individual as proof that a minimum level of competency. Certification typically follows graduation from a formal training program and requires passing a certification exam. The certification is usually earned from a professional society and valid for a defined time, such as 1 year. These certifications must be renewed on a periodic basis and require evidence of completion of continuing education units (CEU’s) and maintaining membership in the granting professional society.

Certification is different from being licensed. Licensing is typically required by state government agencies to demonstrate a minimum level of knowledge or ability as required by law.

Benefits of Certification:

• Distinguishes you from others - gives you an advantage when applying for job over those not certified.
• Shows your commitment to the profession - Shows management that you are improving.
• Improves income potential.
• Demonstrates a basic level of knowledge about the profession.
• Commitment to ethical responsibilities of the profession.
• Improved opportunities for advancement.

There's not a combined medical billing and coding certification, but there are separate certifications for medical billing and medical coding. Medical coding certifications are more diverse and involved due to the complexity of coding. Independent home based medical coders and billers benefit from certification for marketing your credentials to potential clients.

Medical Billing Certification

The American Medical Billing Association (AMBA) is probably one of the most recognized organizations offering a medical billing certificate through examination and education. The Certified Medical Reimbursement Specialist (CMRS) is an exam based certification that demonstrates a knowledge in insurance reimbursement, medical terms, coding (ICD9, CPT4 and HCPCS), claim appeals, and compliance (HIPAA and OIG). The CMRS exam has 16 sections with 700 questions. A score of 85% is required to pass and recieve the CMRS credential designation.

The CMRS Exam is divided into 16 Sections:

• Medical Terminology
• Anatomy and Physiology
• Information Technology
• Web and Information Technology
• ICD-9-CM Coding
• CPT-4 Coding
• Clearinghouses
• CMS 1500
• Insurance
• Insurance Carriers
• Acronyms
• Compliance
• Fraud and Abuse
• Managed Care
• General
• Case Study

Maintaining certification requires obtaining 15 continuing education units (CEU’s) from an approved listing every year. Cost is $325 plus membership in AMBA. AMBA recognizes the CEU’s from courses offered by the AAPC (American Academy of Professional Coders) and many other reputable organizations.

Healthcare Billing and Management Association

The Healthcare Billing and Management Association offers the Certified Healthcare Billing & Management Executive (CHBME) and Certified Medical Billing Associate (CMBA). However these tend to be designed more for executives, managers, and supervisors. Probably the highest level of credentialing offered for medical billing andreimbursement is the RHIA and RHIT certifications offered by the AHIMA (American Health Information Management Association).

RHIA is Registered Health Information Administrator. They are mostly involved with the management of patient health information, medical records, and computer information systems.RHIT is Registered Health Information Technician. They are health information technicians associated with medical records and computer applications and systems.

Medical Coding Certification

Coding credentials are administered by two different organizations - AAPC (American Academy of Professional Coders) and the AHIMA (American Health Information Management Association). Employers may have differing preferences when hiring. If you are considering becoming credentialed talk with an experienced professional already in the coding field and get their opinion.

Here's a summary of their certifications:

AAPC Certifications:

• CPC - Certified Professional Coder
• CPC-H - Certified Coding Specialist - Hospital
• CPC-P - Certified Coding Specialist - Payer
• AAPC also offers several other specialty credentials

AHIMA Certifications:

• CCA - Certified Coding Associate. This is an entry-level certification.
• CCS - Certified Coding Specialist. More proficient coders.
• CCS-P - Certified Coding Specialist - More proficient Physician Based coder.
• CHDA - Certified Health Data Analyst

Medical Billing and Coding Training

Medical billing training is typically not as involved as the training needs for medical coding. If you’re goal is a corporate job, generally the more training and credentials the better. Even if you’re planning to stay strictly in medical billing, having some coding knowledge is very useful in understanding coding errors. A good knowledge of coding also makes you more valuable to an employer and justifies asking for a higher salary.

The amount of training you need depends on your goals – getting a good job at a hospital, large practice, or insurance company - or starting a medical billing business. Smaller practices will usually not be as stringent for certification or training. The downside is they probably aren’t going to pay as well or have the benefits of a larger employer. One of the nice things about a smaller practice is they tend to be more informal.


Medical Billing Training

Training for medical billing can be obtained from a variety of sources such as local vocational schools, community colleges, or distance learning (or online). A good medical billing training program establishes a basic foundation in medical billing necessary for an entry level job. A good certificate program can can take anywhere from 6 to 9 months to complete.

Topics typically covered:

• Keyboarding skills
• Medical terminology
• Medical office procedures
• Billing and insurance reimbursement
• Basic coding
• Medical law (HIPAA) and ethics

There are also reasonably priced (less than $1000) reputable medical billing courses online which can be completed at your own pace. If you are considering an online medical billing school, the material should be written by someone with extensive experience in the field. You should also receive a certificate upon successfully completion.

If you are really eager to learn but don’t have a lot of money to invest, free medical billing training is possible if you are willing to work for a while for little or no pay. This can be a great way to get your foot in the door and establish yourself in the field. That’s how I got started. Fortunately the billing service I worked for paid me well so I saw it as basically getting paid to learn medical billing.


Medical Coding Training

Medical coding training can run the whole spectrum from associate’s degree to a diploma or certificate program. On the longer end is an associate’s degree in Healthcare Reimbursement. Some schools may describe this degree slightly differently. This is the most comprehensive medical coding training and can typically take 18 months to 2 years to complete.

The curricula would typically cover:

• Basic keyboard skills
• Human anatomy
• Career planning
• CPT, ICD, & HCPCS coding
• Billing and insurance reimbursement
• Medical terminology
• Advanced billing and reimbursement
• Office procedures
• Medical ethics and law
• Communications
• Fine arts or humanities
• Mathematics
• Social Sciences

The associates program would prepare a student to take a certification exam by either American Academy of Professional Coders (AAPC) or American Health Information Management Association (AHIMA).

A diploma program is a more abbreviated medical coding training compared to an associate program. This type of program would include more detailed training in procedures and the nuances of healthcare billing. Approximately twice as many courses as the shorter certificate program typicall taking 9 months to 1 year to complete.

The curricula would typically cover:

• Basic keyboard skills
• Human anatomy
• CPT, ICD, & HCPCS coding
• Billing and insurance reimbursement
• Medical terminology
• Office procedures
• Medical ethics and law

The Medical Billing Claim Process

When a patient visits a physician, the doctor writes down the observed conditions and treatment. This information is then given to a medical coder who assigns the appropriate ICD-9 diagnosis and CPT medical billing codes (and CPT modifiers if necessary). The coder may get a written or voice audio dictation file from the doctor that contains the details of the diagnosis and procedures performed on each patient.

The coder may use reference books to look up the correct diagnosis codes (like the ICD-9-CM Expert for Physicians - 2010 Edition) and the corresponding CPT treatment codes and modifiers (CPC-Current Procedural Coding Expert - 2010 Edition). There are also online coding references such as CodingToday that have the latest treatment and diagnosis codes. These services require a subscription for access but can be a real time saver.

It’s very important that the ICD-9 and CPT codes be correct so the claim doesn’t get rejected. Depending on how thorough a doctor is, coding from the providers dictation or handwriting can be very time consuming. However once you get to know the doctor’s preferences and habits the process goes much more efficiently.

This is where the medical billing specialist gets involved. The codes are then typically entered or checked on a superbill or patient encounter form. You've probable seen one of these when visiting the doctor. Some practices now do this electronically. They take the superbill and input the information into the electronic medical billing software. Paper claims are printed out on a CMS-1500 insurance form and mailed to the insurance carrier.

Electronic claims are sent as an electronic file either directly to the insurance company or to a clearinghouse. The clearinghouse takes the claim information, checks the claim for errors, and sends the claim information electronically to insurance companies. Most clearinghouses have a large payer list and can send claims to mostly all of the major insurance companies. This can be a real time saver as each insurer can have different submittal requirements and interfaces. Claims sent electronically are paid much faster than paper claims. Depending on the practice this could be just a few claims or over 40 claims a day.

If the claim is rejected, the medical billing specialist follows up to find out why it was rejected, correct the claim, and resubmit. An appeal may also need to be written and submitted with supporting information to the insurance company.

When a payment is received from the insurance carrier, it is accompanied by and EOB (Explanation of Benefits). This information is then entered into the medical billing software. If there is any patient responsibility such as co-pays and co-insurance, a patient statement is printed and mailed. This is usually done in batches on a monthly basis. Some patients also have secondary insurance which requires a second claim be submitted with the EOB to the secondary insurer.

Sometimes a patient has questions about their bill. This requires the medical billing specialist to look up their account information and explain the charges and why they were not covered. Many patients don't understand the limits of their insurance coverage and must be referred to their insurer to explain.

Diagnosis Codes

Diagnosis Coding

In healthcare, diagnostic codes are used to group and identify diseases, disorders, symptoms, human response patterns, and medical signs, and are used to measure morbidity and mortality. As the plural with the name of this lemma indicates, there will be never one code for all purposes, but many codes for some distinct purposes each.

The codes may be quite frequently revised as new knowledge is attained. DSM changes some of its coding to correspond to the codes in ICD. In 2005, for example, DSM changed the diagnostic codes for circadian rhythm sleep disorders from the 307-group to the 327-group; the new codes reflect the moving of these disorders from the Mental Disorders section to the Neurological section in the ICD.


Commonly used diagnosis coding systems:

• ICD-9-CM (volumes 1 and 2 only. Volume 3 contains Procedure codes)
• ICD-10
• ICPC-2 (Also includes reasons for encounter (RFE), Procedure codes and process of care)
• ICSD, The International Classification of Sleep Disorders
• NANDA
• Diagnostic and Statistical Manual of Mental Disorders or DSM-IV (primarily psychiatric disorders)
• Mendelian Inheritance in Man (genetic diseases only)
• Read code used throughout United Kingdom General Practice computerised records
• SNOMED (D axis)