We are independent & ad-supported. We may earn a commission for purchases made through our links.
Advertiser Disclosure
Our website is an independent, advertising-supported platform. We provide our content free of charge to our readers, and to keep it that way, we rely on revenue generated through advertisements and affiliate partnerships. This means that when you click on certain links on our site and make a purchase, we may earn a commission. Learn more.
How We Make Money
We sustain our operations through affiliate commissions and advertising. If you click on an affiliate link and make a purchase, we may receive a commission from the merchant at no additional cost to you. We also display advertisements on our website, which help generate revenue to support our work and keep our content free for readers. Our editorial team operates independently of our advertising and affiliate partnerships to ensure that our content remains unbiased and focused on providing you with the best information and recommendations based on thorough research and honest evaluations. To remain transparent, we’ve provided a list of our current affiliate partners here.
Health

Our Promise to you

Founded in 2002, our company has been a trusted resource for readers seeking informative and engaging content. Our dedication to quality remains unwavering—and will never change. We follow a strict editorial policy, ensuring that our content is authored by highly qualified professionals and edited by subject matter experts. This guarantees that everything we publish is objective, accurate, and trustworthy.

Over the years, we've refined our approach to cover a wide range of topics, providing readers with reliable and practical advice to enhance their knowledge and skills. That's why millions of readers turn to us each year. Join us in celebrating the joy of learning, guided by standards you can trust.

What is Medicare Coding?

By KS Dunham
Updated: May 17, 2024
Views: 4,216
References
Share

Medicare coding is a specific form of medical coding that provides billing support for healthcare providers giving care to individuals who are covered under Medicare, the United States federal government's insurance program for older adults and adults with certain types of disabilities. Medicare coding service is provided by individuals specially trained in this process. Medical coders often obtain degrees or specialty certifications.

Work as a medical coder requires the coder to look at the description of a medical procedure, disease, injury, or other healthcare service in a healthcare record and then assign the appropriate code to the service. These codes come from several different sources, and may be expressed in numbers only, or in a combination of letters and numbers. Efficient and accurate coding is essential to reimbursement under Medicare coding guidelines.

The most common codes Medicare coders use in outpatient physicians' office are Current Procedure Terminology (CPT) codes. The CPT set of codes was created by the American Medical Association (AMA). The AMA also governs what new codes are introduced, and when codes are changed or subdivided. CPT codes are five digits and only contain numbers.

The CPT codes are the first level of codes using in Medicare coding. A second, more detailed set of codes is known as the Healthcare Common Procedure Coding System (HCPCS). The HCPCS codes are also five digits, but the codes always begin with a letter, followed by four numbers. These codes cover not just procedures but other type of healthcare-related services a physician, nurse practitioner, nurse, medical assistant, or other professional could provide. These might include medical transportation, patient education, or certain occupational therapy or physical therapy procedures.

People working in the field of Medicare coding do not have every HCPCS or CPT code memorized, although an experienced coder may be able to assign many codes without consulting reference material. Instead, coders use books or specifically designed software to determine the appropriate code for the service described in the medical chart or record. Although computerization of medical records has in some cases decreased the need for medical coders in large institutions, smaller institutions and single doctor practices are usually still in need of coders. Often the sub-specialty of Medicare coding is outsourced to individuals who do coding and billing from home. This can provide a substantial savings to healthcare agencies that then do not have to pay benefits or provide space in order to receive this service.

Share
WiseGeek is dedicated to providing accurate and trustworthy information. We carefully select reputable sources and employ a rigorous fact-checking process to maintain the highest standards. To learn more about our commitment to accuracy, read our editorial process.
Link to Sources

Editors' Picks

Discussion Comments
Share
https://www.wisegeek.net/what-is-medicare-coding.htm
Copy this link
WiseGeek, in your inbox

Our latest articles, guides, and more, delivered daily.

WiseGeek, in your inbox

Our latest articles, guides, and more, delivered daily.