What is a Certified Professional Coder?

What is a Certified Professional Coder

Have you ever wondered, what is a certified professional coder? A medical coder plays a crucial role in the health industry.

The main function of a medical coder is to review the health records of a patient along with other supporting information to code and classify the diagnosis and procedures performed on the patient.

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The numerical code assigned to the diagnosis and treatment process is then entered into the database so that the healthcare professional is paid appropriately for their services.

Features of a CPC

A medical coder conducts a comprehensive review of the medical charts and other related reports of a patient to verify the presence of all necessary components, including health records, operative reports, necessary signatures, tests, dates, and any other pertinent information that is necessary for inclusion.

In addition, a certified professional coder verifies that the diagnosis is indicative of the care and treatment that was given.

The coding must be in compliance with the standards set by a variety of groups including insurance companies, American Medical Association, manuals, and other reimbursement agencies.

Functions of a CPC

A medical coder is required to assign and enter the proper diagnostic code in order to establish the amount of money that the insurer will pay the health care professional or facility.

In order to ensure consistency in billing, the medical coder must implement a standard classification system such as the CPT, HCPCS, APC, DRG, or ICD. The accuracy of the code is crucial, because it is the foundation that ensures a timely and maximum reimbursement.

In addition, the medical coder also has a direct impact on the accreditation of the medical provider or facility, decision making of the clinicians, patient care consistency, and takes the time to research statistical information and data used by health care providers.

Medical coders are in constant communication with other medical personnel, federal/state agencies, patients and families, employees at other medical facilities, and insurance companies.

The intent of this contact is to discuss information- especially if there is a medical claim that is denied. The medical coder will also be able to explain pertinent insurance benefits and procedures to clients.

They make sure that they are aware of the policies of the insurance provider and are able to oversee in-house activities such as scheduling of appointments, bookkeeping, and other tasks.

Types of CPC

Typically, a medical coder will work in a medical office or other healthcare facility- though, in some cases, they may be working from their home. The specific duties of a CPC is dependent upon their specialty. Within the arena of medical coding, some of the occupational titles include:

  • Claims analysts
  • Claims processors
  • Claims reviewers
  • Coding coordinators
  • Coding specialists
  • Electronic claims processors
  • Medical collectors
  • Patient account representatives

The data coded and entered by the CPC will also vary according to the particular setting they are working in. for example, a CPC working with cancer patients will focus on the accuracy of data related to the various cancers that are treated in a healthcare facility. They utilize a registry to obtain information used to research this area, follow up with patients, and advance public health care programs for cancer.

Education and Employment for CPC

A medical coder must possess ample knowledge of human anatomy and physiology, current diagnoses, medical terminology and abbreviations, surgical procedures and techniques, and pharmacology.

In addition, they must make sure they are familiar with official standards and rules regarding coding set forth by the AMA, and CMS- which identify and assign procedural and diagnostic codes.

A medical coder is typically required to go through specific training and have some credentials such as the Accredited Record Technician’s certification- known as ART, or Certified Coding Specialist– known as CCS- designation, as well as further requirements that are mandated by the AHIMA and the AAPC. A company is much more likely to hire a medical coder that is a RHIT (Registered Health Information Technician).

When a coder is RHIT, this means that they have successfully passed the AHIMA exam and obtained an associate’s degree from a program accredited by the Commission on the Accreditation for Health Informatics and Information Management Education.

So, next time someone asks you, what is a certified professional coder, you can explain to them what it is. According to the US Department of Labor Occupational Outlook Handbook, demand for medical coders is likely to increase much faster than other occupations due to the rapid increase in medical testing, procedures, and treatments that are being scrutinized by consumers, health insurance companies, and others involved in the medical treatment process.

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Med Coding Pro

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