A community of 30,000 US Transcriptionist serving Medical Transcription Industry

coding versus billing - just curious

Posted: Apr 14, 2010

Can anyone explain the difference between coding and billing? Do coding credentials apply to billing too?

in a nutshell... - sm

[ In Reply To ..]
A "coder" is the one who INPUTS the medical codes primarily for insurance billing purposes. This code is basically a number that corresponds to the reason for the visit, test, etc., and must mirror the chart note. If the patient was seen for lumbar back pain, the code must be for lumbar back pain and not just back pain, etc.

A "biller" is the one who actually SUBMITS the bill the patient as well as the insurance company. They also record any payments received.

The coder & biller are usually the same person but not always.

In a hospital though, they are in 2 different departments - very different and separate - Hon

[ In Reply To ..]
In a doctor's office they are often the same person. In a hospital they are done in totally different departments, completely independent of each other.

I am a recovering biller. I was never a coder. - CrankyOldBroadOnTheBeach

[ In Reply To ..]
I worked in billing in doctors' offices for more than 3 decades. In each and every case, the DOCTOR was responsible to make sure that procedures were correctly coded. (How in heck were we supposed to know exactly what they did to that patient behind that closed door??) However... they did give us diagnoses "in English" and we looked up the codes ourselves. Sometimes we'd have to go back and ask them for more specificity, so we could code to the last possible digit past the decimal point.

(Procedure and diagnosis codes are two completely separate and different things.)

We had one real smart-a** doctor in the oncology practice who, when we'd go to him and say what does so-and-so have, he'd get all coy and cute and say "cancer." Yeah. Right. WHAT KIND OF CANCER?? WHERE?? I wanted to slap him sometimes.

My boss doc once answered the same question with "she's got a rash." I said, well, why on earth isn't she at the rash doctor for that? He said she'd already been to the dermatologist and wanted a second opinion. From an oncologist?!?! Huh?

We also used to have to "load up" the diagnosis list for hospitalized patients, because apparently a cancer diagnosis was not enough, in the eyes of Medicare, to justify multiple hospital days. So we'd go looking, and usually we could find plenty. (Hypertension, diabetes, osteoarthritis, some form of heart disease, etc., etc.)

The medical reimbursement hokey-pokey has gotten so crazy in the last 15 years or so, I have often said I would clean filthy toilets with my bare hands before I'll go back to billing. However... if the medical transcription industry continues to slide downhill, I might consider looking into coding. That's a place where you do your job and pass it along, and you don't have to constantly fight with the insurance companies to get payment for covered, authorized treatment. Nor do you have to listen to patients who drove up in a Mercedes, are wearing more than my annual salary in bling, and live in the richest part of town, whine about how they just can't manage to cough up their co-payment today. Grrrr.

Billing/coding - Anonymous

[ In Reply To ..]
Why did you have to ask the doctor for specifics? Couldn't you abstract the information you needed from the patient record to code past the next decimal point?

In regard to your last comment, judge not, well you know the rest....

Very good reason for it... SM - CrankyOldBroadOnTheBeach

[ In Reply To ..]
Our practice management people REQUIRED us to get those charges posted and the claims out the door within 24 hours of the patient being seen.

However... the doctors often waited until the weekend to catch up on their dictating, which meant we often had no written record to search for a more specific diagnosis for that visit. This especially happened with new patients, or for an established patient coming in for a new problem.

If we wanted to keep management happy, we had to go bug the doctors for diagnosis information, so we could bill.

Another wrinkle in the fabric was that in addition to being head of the billing department, I was the sole MT for the practice, and even after I finally got all of the docs trained to dictate their new patients separately, and STAT, there were only so many hours in the day that I could manage to stay awake, and transcribe those reports. My main boss would dictate all of his new patient visits for the entire week over the following weekend--LONG past our billing deadline.

So that is why we sometimes had to ask doctors for more specific diagnosis information. Clear as mud? :)

Coders vs billers - Redpen

[ In Reply To ..]
In some offices, the person who submits claims uses the doctor's codes to prepare the bill, send it in, and handle the payment. That's mostly a billing function.

Coders come into play when an office or facility decides to have their codes assigned by a professional who is responsible for reading the record, evaluating the adequacy of documentation, assigning the diagnosis and procedure codes, and, if necessary, contacting the physician to get the documentation clarified. The coder does this keeping in mind all the complex rules about documentation, coding rules pertaining to the code sets, rules applied by Medicare and other third-party payers, and so forth. At hospitals and larger clinics, the codes form the basis for statistical data collection, as well as serving for billing. The codes are then picked up by billers, who prepare the bill and handle the payments.

Physicians are responsible for the accuracy of the coding which they bill. However, the facility is responsible for the coding which it bills. Having a credentialed coder on staff helps physicians and facilities demonstrate that they are making a valid effort to comply with the standards of ethical coding and billing.

Coding and billing are much more complex now than ever before. Third-party payers try to get out of paying, and they strictly limit payments to medically necessary treatments. Professional coders keep up with this mess of ever-changing rules, thus enabling both offices and facilities to avoid submitting erroneous claims. They help physicians and facilities avoid being audited and to deal with audits when they occur.

As someone just mentioned, when she worked in billing, it was a good thing that physicians provided the codes because you couldn't tell from the documentation. Well, today, if the documentation isn't clear, it is considered to be deficient. "If it isn't documented, it wasn't there or it didn't happen."

What went on behind those closed doors? Exactly what is written in the record. If there is nothing written there, then nothing happened and nothing gets billed.

What does that patient have? Exactly what is WRITTEN in the record. If what is written doesn't justify the service provided . . . well, the insurance company doesn't have to pay.

Getting money is becoming increasingly difficult. More and more physicians turn to professional coders, either on a full-time or consulting basis, to help them stay on the straight and narrow and bring in the $$.

Redpen - question please, if you don't mind - answering ... sm

[ In Reply To ..]
If one works at home as a certified coder, how are they paid? By the hour? By the chart? % of coded charges?

And what is a reasonable average annual income from a full-time certified WAH coding position?

Thanks so much.

Answer - Redpen

[ In Reply To ..]
Most contract coders I know are paid by the record. That might be one encounter (office visit, ER visit, ambulatory surgery record) or one hospital stay. Some work from home and some travel to client sites a few days each week.

An increasing number of facility coders now work from home, even those working for the federal government. I think you'll see this increasing over time. Those coders are employees who are paid by the hour or on a salaried basis. There will be production expectations they need to meet, of course.

There is a willingness to pay for good coding, because it directly affects revenue.

The best general guides to salaries are the annual salary surveys on the AAPC, AHIMA, and Advance for HIM websites.

For comparison, you can look at the federal salaries. Coders in the VA may begin at GS-6 if they have little experience and and go to GS-8, with most regular coder positions at 8. More advanced positions are at the GS-9 and 11 levels. Some may be 12s. Just google "federal pay scale" to see what those salaries are (it varies by geographic area). Be sure to add about 30% to that for benefits.

Thank you, Redpen. Appreciate the answers. - CB - You know what you can do.

[ In Reply To ..]
I have never stuck my nose into your topics.

You're so bent out of shape with an axe to grind it's amusing.

Keep your MT topics on the MT boards. This one is about billing and coding.

Axe to grind? ME??? Hardly.... - CrankyBeach

[ In Reply To ..]
I dare you to point to one single post where I have ground a single axe.

I also dare you to post a remark like that with a regular nickname/alias, instead of hiding behind anonymity.

And since I was a biller for more than 3 decades (as well as a billing supervisor), I think I can speak with some authority on the topic.

I was simply pointing out the glaring cognitive dissonance (at least, as I saw it) of hospitals being willing to pay well for accurate and expert coding, but not willing to pay a decent wage to the people who produce the documentation required for accurate coding.

If I am grinding any kind of an axe, that would be the one--except today is the first time I have EVER said such a thing.

I'm glad you're here, Cranky. - :)

[ In Reply To ..]
I am interested in what you have to say. Thanks for posting.

I'm glad Cranky is here, too. (nm) - Redpen

[ In Reply To ..]
nm

Thanks, Redpen and ":-)" - CrankyBeach

[ In Reply To ..]
I'm glad to be here too. I think.

With all the folks talking about "jumping the fence" to the coding side of The Force, I'm kicking an idea around in my head.

The local community college has a medical assisting program that includes a one-semester coding course. I'm thinking of taking it... not because I think it would make me ready to take on the coding world, but because it would give me an idea of whether or not that would be a fence I might want to jump, if the MT field goes any further down the porcelain fixture.... It's entirely possible that, given a taste, I might like it enough to make the investment in a "real" coding course. It is equally possible that I might come out at the end of the course wanting to stick a pitchfork in my own brain. A couple hundred bucks (that's a guesstimate) and giving up my Thursday nights for one semester is a risk I'm willing to take, rather than commit myself to much more $$ and then discover I can't stand it after all.....

If anybody has any thoughts on my tentative plan, I'd be interested to hear them.

Hey CB - Jm

[ In Reply To ..]
I think it is good to check it out first while you are getting some education in medical assistant. You are already in the field and have all that medical terminology knowledge, so you won't be jumping without some loot in your pocket to give you a good start. Just be aware, there are still documentation issues like you talked about in your "recovering biller" post.

Just to clarify... I am not doing the medical assisting course. - CrankyBeach

[ In Reply To ..]
I'm just thinking about taking the coding class (assuming they'll let me) to see how I like it. I have NO desire whatsoever to become a medical assistant. [shudder] I'm sure it's a wonderful career for those whose gifts lie in that direction. I am not one of them. :)

Nor do I want to do any of the other jobs in the doctor's office. I've already done pretty much every job that didn't involve actual hands-on patient care. (Reception, medical records, biller, transcriptionist, computer geek, doctor calmer-downer, chief cook, bottle washer, changer of light bulbs, adjuster of attitudes, and worker of miracles.) Been there, done that, and they couldn't pay me enough to do any of it again.

As some folks here have mentioned, anybody who is already an MT (and I've been one for 38 years, and have my CMT) is at least one jump ahead, because we already know our way around a medical record, and presumably have some grip on the language. I think I can safely say I have that.

And as others have mentioned... as far as the documentation issues, if I understand the coding gig correctly, it ain't my problem, 'cause if it ain't documented, it didn't happen. And if it's documented but badly so, it still ain't my problem, 'cause I didn't do it. Garbage in, garbage out.

Anyway, thanks for chiming in. I may not be making sense. It's well past time for my nap!

Trying out coding - Redpen

[ In Reply To ..]
If you find out what book they use, I might be able to tell you what they'll be teaching, Cranky.

Medical assisting courses typically teach a combined coding/billing affair that focuses primarily on small office "front-desk" activities. This may range from making appointments, to checking in patients, collecting their copays, locating their medical records, and then checking the patients out, transferring the codes the doctor checked on the charge ticket to the claim, sending in the claim, processing the payment, and then doing bill collection on any unpaid amounts.

However, courses like this aren't really teaching "coding." They may call it "coding," but they're teaching medical front-office.

But, it's useful information and you might enjoy taking a class in it, if for no other reason than to see how things like that are taught.

Just don't come away from it thinking that it's a good reflection of what coding is like. Medical assisting courses teach "transcribing," too, but the typing they are taught is nothing like what a medical transcriptionist does. The "coding" they teach is about the same--it involves putting codes on claims, but the fact that codes are involved doesn't make it what my coworkers and I do.

They will tell you about ICD-9-CM and CPT codes, so you will get to see what those are and how they're used, but that will likely be only one chapter out of 12 or 15 in the book. :)

The next time they offer the class is fall 2010. - CrankyBeach

[ In Reply To ..]
So I will have plenty of time to track down the instructor, or at least the department head, and get some more specific information (including the proposed textbook). And even if the course isn't "coding" as practiced in the real world, it still might give me an idea whether it's something I'd want to consider pursuing, if MT-ing goes any further down the porcelain fixture than it already has.

Here is the course description from the college catalog:

MEDA 113 MEDICAL PROCEDURE CODING
3 units â�¢ LG-P/NP â�¢ Two hours lecture; three hours lab
This course will introduce the student to theory and procedure of
accurately and legally coding for medical procedures, an increasingly
essential healthcare communication system. Using simulated
medical/billing records, the CPT-4, HCPCS and HCFA guidelines will be
broadly utilized to develop practical skills and proficiency. It is strongly
recommended that students complete MEDA 105 or have a working
knowledge of medical terminology and be eligible for English 111 and
112 or ENSL 110 and 155. May be repeated provided there has been a
change in the codes as documented by the department.

(MEDA 105, the not-quite-a-prerequisite, is the medical terminology course. As a CMT, I think I have that aspect fairly well covered.... The program also includes separate courses in medical office management, finances and computer applications, insurance management, diagnostic coding, and of course "records and transcription." All the other courses appear to be more clinically hands-on.)

I could probably teach the computer software and insurance courses in my sleep. I became a biller back when they were still called RVS numbers, and HCPCs were still just an evil twinkle in somebody's eye.... And back in those days, we could still get away with submitting claims with the diagnosis "in English" if we couldn't find a code. I don't think we even owned a diagnosis code book in that office.... But we couldn't get away with not using an RVS number, even though the claim forms of the day included a place for the procedure description....

I might also note that in my billing career, I spent a lot more time in the ICD-9 book than in the CPT book, and at one time I could practically quote all the oncology diagnosis codes down to the 5th digit, from memory. I also spent a LOT of time rummaging through written records, trying to find the highest levels of specificity that I could. So I don't think the diagnosis coding class would be a whole lot of use to me. Not to mention, it isn't offered again until a year from now....

Coding trainin - Anonymous

[ In Reply To ..]
As a student in a more in-depth coding program, I would say this is a good place to start. If you want to pass the CPC or another certification exam, I would suggest more training, particularly in regard to the EHR and the use of encoder software. You will need to have more than a basic knowledge of HIPAA as well. I'm glad that you are so confident in your knowledge of terminology and anatomy. I've been an MT forever and thought I would gloss over the terminology module in my program, it was a real eye-opener when I saw how much I had taken for granted. I would also say that you'll probably get some surprises in regard to computer software, but it's always good when one thinks they know more than the instructors. Anyone can memorize diagnosis codes, it's knowing how to apply them appropriately that is important. Good luck.

Should have been coding training, sorry! - Anonymous

[ In Reply To ..]
No message, just noticed my typo!

Textbook for the DIAGNOSTIC coding class is... - CrankyBeach

[ In Reply To ..]
Step-by-Step Medical Coding 2010 Edition, by Carol Buck.

The campus bookstore website only lists the textbooks for the current semester, and the PROCEDURE coding class (the one I am thinking about taking) is not offered this semester.

The above book is required; the Stedman's abbreviations book (which I own) is recommended.

Does that tell you anything, Redpen?

The book - Redpen

[ In Reply To ..]
Yes, that tells me a lot. It will probably be the same book for your CPT class, because it covers both diagnosis and procedure coding.

It is used for a lot of coding classes at colleges and at least one professional organization. They often use it since it comes with online "teaching" software which the student works through, answering questions and taking tests online.

If that is what they are using, you should learn appropriate CPT coding. You might be able to pass a certification exam after finishing it, if you devote some review to ICD-9-CM. Maybe.

When MTs learn coding, they have an advantage in that they already know much of the medical underpinnings. Textbooks not only tell you about the code set itself, but about the procedures involved--what they are, terminology used, etc. You'll find that part very easy, and I think you'll find the rest interesting.

One of the particular advantages MTs have with CPT, I think, is their ability to understand what is being described in the procedure codes. Since you'll have transcribed operative reports, you'll recognize the procedures quite readily and will be able to sort out the details. You'll be able to find the details in medical reports, too, where they are often hidden in the text and do not appear in the title of the procedure performed. Non-MTs have to learn to do this from scratch.

Remember that some college courses use only that book for CPT coding, so you're getting the same material.

Don't let it frustrate you. It can be frustrating, particularly if your instructor is not a procedural coder with experience spanning the entire spectrum of the CPT code set (all medical specialties . . .). If you have questions, remember that I'll be happy to answer them.

Similar Messages:

Jan 18, 2010

Does anyone have an idea which career might pay best, medical transcription or medical billing/coding? I am curious about which pays best. ...

Aug 13, 2013

Accepted a job, gave 2 weeks notice, and yesterday was my first day. I was to be helping out transcription (1000 jobs behind), and then sitting with billing and training with coding as their coder will be out on maternity leave in December. The office is adding another surgeon, and they are rapidly expanding. So I gave a proper 2 weeks' notice to my former employer (2 hours on the road there and back, low salary - now less than half distance and $3 more an hour) and starte ...

Apr 20, 2010

has anyone thought about or actually made the swith from mt to billing/coding? ...

Jan 11, 2011

Anyone know if MedQuist has coding/billing jobs and would hire a new grad from CareerStep? Thanks! ...

Apr 05, 2011

Quick question - medical billing and medical coding are two totally separate entities, right? Meaning, you have schools for billing and schools for coding or schools that teach coding OR billing.. Just had a discussion with someone regarding this and I would like to have my facts straight ... thanks everyone!!! There are billing jobs and coding jobs, but the two shall never "meet", right? ...

Apr 11, 2011

I have a stupid question. When I finished my MT course with Allied Medical School, I then found out they are NOT (federally) accredited, they do not assist you in finding positions, and they do not assist in helping you become certified. In other words, I felt that I wasted all of that money. As a newbe I was unable to find a job. I started apprenticing with a company, paid their $500 fee for software, and after 8-9 months, found they had changed their name. Apparently, they were getti ...

Sep 30, 2011

I have been an MT for 20+ years and now looking into coding and billing... Would you recommend it? I am considering this, but looking for some words of wisdom prior to making a decision. I see Career Step offers the program, but not familiar enough with Career Step to know if they are a reputable. I have been told that coding is on its way out like transcription and not to waste my time, but only heard that from one person so far. Anything you can share with me would be great! Thanks :) ...

Oct 30, 2014

It has been almost 8 months since I passed my CPC on first try. I have been in MT field for more than 14 years, and yet nobody is ready to give me a job based on that. Everyone says u dont have a coing xperience. Is anybody else suffering like me out there? I am slowly losing hope that I will ever be able to leave this field. ...

Jun 15, 2010

I have a background in medical transcription however I am unable to sit in the same position (foot pedal - headset - typing) for any length of time. I broke my neck many years ago and didn't know when I was in school that this was going to prevent me from doing this career on even a part time basis and after graduating with high honors and having great employee/employer relationships. I am wondering if it is feasible to do billing and coding with medical transcription in a home offic ...

Aug 30, 2010

I had a friend suggest I access this webiste for possible information on Medical Billing/Coding training. Do you have any suggestions on where to obtain training and certification for Medical Billing/Coding. There are 2 of us that would be interested in this and then to move onto the Medical Transcriptions. We would both like to work from home and spend time with our children. Any information would be greatly appreciated. Thanks in advance for your assistance. ...

Jul 11, 2011

I am looking at options/alternatives. Currently an MT with 15+ years. Can someone tell me what a coding job and/or billing job exactly is (job description)? What is required of a coder/biller? Is it a WAH job? Thanks! ...

Sep 16, 2011

Just lost my part-time transcripton job and starting to hear that this field is becoming extinct. Thinking about going to school online for billing and coding. Anybody know of a oustanding accredited school? Do not want to waste time and money barking up the wrong tree. Is it costly? ...

Mar 13, 2014

I have been an MT for seven years and for the most part do enjoy the work, but find the "feast or famine" nature of the work difficult to make a decent living. I will soon be divorced and won't have my husband's income to help support the house. I have been thinking about training for medical coding and/or billing and am looking into different online courses. I was considering a bundled course at MedicalBillingCourse.com. Has anyone completed this course an ...

Mar 30, 2014

I have been transcribing for over 20 years and would like to add billing and coding to my resume. I have heard Penn Foster is a good online school that is accredited. Any thoughts to help me make a decision? ...

Apr 26, 2014

I am wanting to go into billinig/coding. There is a tech school very close to my home. They have coding/billing program which takes 1 year to complete full time. I am wondering this: How much does a newbie make just starting out in either billing or coding and what are my chances of getting a newbie job right out of school? Thanks for the info. ...

May 29, 2014

As a starving MT, I am going to take the plunge through AAPC to enroll either in their coding or billing program. I cannot afford both. Actually, I cannot afford either, but I feel I have to invest in the future away from MT. I've read the forums at AAPC, and some are saying there are too many credentialed coders and not enough jobs. I do not know what the job impact will be, if any, once ICD-10 is implemented, if it is implemented, and the need for more coders. ...

Dec 31, 2014

I'm thinking about making the transition from transcription to coding/billing. What are the best schools to attend? I have seen many courses online, but not sure which ones are the best. Thanks! ...

Jan 30, 2015

okay ladies and gents--I got a lot of negative reviews on the MT world and have decided that is not a route worth going down....however, we have a small child, and come July will have two! We can't afford daycare full time for 2 babies. I was counting on working from home. Do you guys think coding & billing is worth it? Do you enjoy your jobs? Are many of you able to work from home? Is Andrews the reccommended school? About how long does it take to actutually complete the ...

Feb 03, 2015

I am currently a transcriptionist with 7 years' experience, and I am considering going back to Andrews for either coding or billing. I am trying to decide what field I want to get back into, and pay versus school time is really the determining factor for me right now. To anyone wililng to answer, especially if you are an Andrews graduate, how long did it take to get through your billing and/or coding program? Also, if you don't mind answering, how much do you make now? Do you work at ...

Feb 13, 2015

Does any one know of any good medical billing and coding schools online? ...

Nov 16, 2009

I was wondering if anyone who is a transcriptionist also does medical coding/billing. I wonder if we are any safer with this field and what the pay is like. It looks to be about the same from what I have found on line. I have been doing transcription for 10 years and am getting tired of what is happening in the industry. It is tedious, hard work to sit on your butt all day and only get paid when your fingers are on the keys. I am thinking of working in an office or hospital for a chang ...

Jun 28, 2010

Thinking of taking billing/coding courses since transcription is going downhill. Any good on-line schools that are AHIMA accredited? Do you have to take courses only accredited by AHIMA? What about their courses? Any suggestions and/or help would be appreciated. (Also, I don't want to take a course that takes years to complete.) Thanks in advance! ...

Sep 01, 2010

I have never coded/billed for physical therapy. The scenario is: eval (97001), application of hot/cold packs (97010), and 3 minutes of ultrasound (97035). I checked the cms website and other sites relating to physical therapy, but they are all unclear. Should I bill/code this as 97001 and 97010-59? ...

Sep 08, 2010

I am interested in obtaining some information on the medical billing/coding certifications. If anyone has class or school informaiton that is realiable I would greatly appreciate it. I am looking for online certificated classes. Thanks ...

Nov 14, 2011

I am a medical transcriptionist that has been typing radiology the last 11 years. My job is going to be phased out by voice recognition soon. I'm thinking of going back to school for medical billing/coding. Has anyone else made this transition? Do you like or hate it? ...

Feb 08, 2012

I have a question about coding and billing. For three years in the '90s, I coded and transcribed for a small, rural, hospital. I was responsible for outpatient, ER, inpatient, surgical etc. coding and transcription. It was mostly ICD-9, and HCPC coding. If I want to code from home in the future, what would you suggest I do, an online program? Do you think coding from home would be an opportunity or do most hospitals/clinics/physicians require experience at a facility first, and wo ...

May 05, 2012

How plentiful are the jobs for coders and medical billers? Currently I am an MT but looking into other career options. Thanks! ...

Aug 03, 2013

gotta be honest, i despise medical transcription - booorrrrring - BUT i still want to work at home. i know coding/billing probably isn't any more interesting, but because i still want to work at home, i'm considering learning it. does anyone have any knowledge and/or experience with it? if so, is it, too, also going overseas? are there any work at home jobs that are not going overseas? ...

Oct 07, 2013

Hello out there. Are there any medical coding and billing sites like this one. Any information on websites or where to look would be greatly appreciated. ...

Feb 25, 2014

I need to make a switch if I should lose my transcription job. Which would you recommend to get into first? Wondering if I should take a medical billing course first which would help me get hired somewhere else and does have a billing background help with coding?? I have a local vocational school that offers a medical billing course but nothing nearby that offers coding. Also I would prefer to do an online course and not sure which one would be the best. I don't want to spend money if ...