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What is a usual day in the office for a medical coder?

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Jennifer’s Answer

I’m a surgical coder for general surgery, orthopedics and pain management. For a literal run down of a day, I have a routine for all the specialities I work. Keep in mind before I start, Not all coders do specialities; some do family medicine or inpatient coding while others do registration, trauma coding. There’s dental and behavioral health, and quality management and auditing. Sometimes it takes a while to find your groove but once you do it’s awesome.

A typical day for me look something like this:
- I clock in (I work remote now but I did work as a site coder) check my email first and then pull up the systems I use throughout the day, Epic and GECB. As well as a resource given to us, encoderpro.com for codes
- since I work multiple specialities, I work one at a time and in the same order, PM, Ortho then GS
Within the systems I have a work queue that continuously has encounters from the practices I’m assigned to being put in from the physicians.
- 80% of the time is active coding, I read operation notes, office visits, office procedures, pathology reports and sometimes radiology or imaging reports to get the correct diagnosis codes (ICD-10) and procedural codes (CPT) for the encounter the physician has with the patient. Sometimes it can be one code, sometimes is can be 10 for a single encounter, it all depends on what happened at that time. I can only speak for surgical coding but I find it fascinating. You get to be clinical without patient facing.
- the other 20% is the other part of the job, communication. Communication with the physicians if they have a question or you do about a procedure. Something to remember; The physicians want you to ask; you’re essentially making sure they get paid. You’re also communicating with your team members, sharing the work queue and learning from one another. Getting trained by your manager and team lead, communicating with Quality Management for better coding, getting audited and reviewing them for learning opportunities, keeping up your CEUs for your certification, and studying. Lots and lots of email. Things in coding change a lot and as a coder, you’re responsible to stay on the up and up. I tend to write in my code books: notes to remember for certain procedures, key words for a diagnosis. In my first code book, I grew a lot of diagrams to help with the anatomy.

I hope this answer helps, I know it’s a lot of information. I’m never bored at work. There is always something new and different to learn.

Jennifer recommends the following next steps:

Check out aapc.com for training, types of certifications, list of specialties, webinars and info about coding and coders
Check out ahima.org for training as well, it’s just a different certification from CPC
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James Constantine’s Answer

Dear Kyanna-Marie,

Understanding the Role of a Medical Coder

A medical coder is a key player in the healthcare field, tasked with converting medical diagnoses and procedures into a universal language of codes. These codes are crucial for insurance billing, ensuring accurate medical records, and bridging the communication gap between healthcare providers and insurance companies.

A Glimpse into a Medical Coder's Daily Routine

The duties of a medical coder can vary based on their work environment, but here's a snapshot of a typical day:

1. Examining Medical Records

The day for a medical coder usually starts with a thorough review of patient medical records. This includes clinical documentation, physician notes, diagnostic tests, and treatment plans. They make sure all the necessary information is accurate and ready for code assignment.

2. Allocating Codes

Afterwards, medical coders assign codes using the International Classification of Diseases (ICD) for diagnoses and Current Procedural Terminology (CPT) or Healthcare Common Procedure Coding System (HCPCS) for procedures. They pinpoint the right codes based on the patient's condition, diagnosis, and treatment provided by the healthcare provider.

3. Teaming up with Healthcare Providers

At times, medical coders might need to connect with healthcare providers to clear up any unclear or incomplete documentation. This teamwork ensures precise coding and minimizes the chances of claim rejections or audits.

4. Managing Electronic Health Records (EHR)

Medical coders frequently interact with electronic health records (EHRs) to input and pull up patient information. They might also need to update EHR systems with new codes and ensure the coding documentation is accurate.

5. Handling Insurance Claims and Follow-ups

Once the codes are assigned, medical coders prepare and send out insurance claims for reimbursement. They also manage any necessary follow-ups or appeals related to claim rejections or underpayments. Keeping an eye on coding compliance, carrying out internal audits, and staying updated on coding guidelines are crucial parts of their role.

6. Pursuing Continued Education and Professional Growth

Medical coders need to keep up with industry regulations, coding updates, and advances in healthcare technology. They often engage in ongoing education courses, webinars, or conferences to keep their coding skills sharp and certifications valid.

May God bless you!
James Constantine Frangos.
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Melissa’s Answer

It’s pretty basic depending on the type of coding and facility. You come in, charts are loading in your queue and you have to make your productivity. Sometimes you may be place on QA to ensure your accuracy and speed are up to standard. It entails a lot of research. And constant learning
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ISHIKA’s Answer

Medical coding is translation of medical healthcare records into alphanumeric codes..and paved the way for medical billers to bill the claim for a particular insurance company
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Aleksandra’s Answer

Medical coders translate medical procedures into a standardized code so insurance companies can assess financial obligations and create invoices for services provided. ... The daily duties of a medical coder are tri-fold -- obtain data from charts, research codes and enter information on a computer.
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Amber’s Answer

Hi Kyanna-Marie,

Medical coders can work in hospitals, health care systems, specialized medical centers, healthcare offices, medical schools, or remotely, just to name a few. Generally, no matter what type of facility they work in, coders will work patient encounters by reviewing clinical documentation for services and diagnoses in order to code them for accurate reporting and proper payment from insurance carriers.

Coders spend time researching services, collaborating with medical providers, and communicating with insurance companies, all while staying up-to-date on coding changes and healthcare standards.

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