Medical Billing vs. Medical Coding in Healthcare

Medical Billing vs. Medical Coding in Healthcare

While both sound similar, medical billing and medical coding are distinct parts of healthcare administration that work together to ensure providers receive payment for their services. While both are involved in the revenue cycle, they have distinct functions and require different skill sets. Understanding these differences is essential for those seeking healthcare careers and those managing healthcare organizations.  

Medical Coding  

  • Involves assigning standardized codes to diagnoses and procedures performed by healthcare providers. 
  • These codes translate medical records into a universal language for billing and record-keeping. 
  • Medical coding plays a role in clinical documentation improvement (CDI) efforts. Accurate coding depends on comprehensive and precise clinical documentation, which benefits patient care, billing accuracy, and data integrity. 
  • They analyze medical records, translating them into billable codes and ensuring they meet coding standards. 
  • These codes are used for billing, statistical analysis, quality reporting, and reimbursement. 
  1. ICD-10-CM (International Classification of Diseases, 10th Revision, Clinical Modification): Used for coding diagnoses and reasons for healthcare encounters. 
  1. CPT (Current Procedural Terminology): Used for coding procedures, services, and treatments provided by healthcare providers. 
  1. HCPCS (Healthcare Common Procedure Coding System): Used for coding supplies, equipment, and services not covered by CPT codes. 

Medical Billing  

  • Refers to collecting payments from patients and insurance companies for healthcare services. 
  • Billing is divided into the front-end (verifying patient insurance) and back-end (claim submission). 
  • Medical billers track claims, follow up on unpaid invoices, and address any issues with insurance companies. 
  • Clear explanations and customer service skills are essential for interacting with patients about billing matters. 

How Billing and Coding Work Together 

Medical billing and coding tend to go hand in hand, working to ensure providers get paid. Coders translate medical services into codes. Billers use those codes to submit claims for payments.  

  • Maintaining Accuracy: Coders and Billers double check codes to avoid costly claim denials.  
  • Staying up to data: The world of medical coding is constantly evolving, with updates to coding system like ICD-10 and CPT occurring annually. Both coders and billers need to stay informed about these changes to maintain coding accuracy and ensure claims reflect current standards. 
  • Denial Management: Coders may need to review medical records to provide additional documentation, while billers handle appeals with insurance companies.  
  • Technology Impact: Software automates billing tasks, boosting coders and billers’ efficiency for complex work.  

Challenges in Medical Billing and Coding 

  • Accuracy is Paramount: A single coding mistake can lead to denied claims, impacting revenue. 
  • Meeting Deadlines: Insurance companies have strict time limits for claim submissions and missing them can result in lost reimbursements. 
  • Keeping Up to Date: Regular updates to coding systems and regulations require constant learning for billers and coders. 

Should You Outsource Medical Billing and Coding? Consider the Benefits 

Outsourcing medical billing and coding can significantly improve a healthcare provider’s bottom line and free up valuable time for patient care. Medical billing specialists handle the complexities of claim submissions and denials, maximizing revenue collection. In-house staff can then focus on delivering quality care. expEDIum offers software solutions to streamline the claims process regardless of your chosen route, ensuring efficient medical billing and coding. Contact us for more information.  


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