What Does a Certified Medical Coder Need to Know about Medicine?

Medical coding is the heart of the healthcare industry. It keeps doctors and nurses on track and organized, and shows in clear terms a patient’s medical history. One slip-up with an improper code could be big trouble for a patient. You wouldn’t want to mistakenly code a lymphoma (cancer) for lipoma (benign fatty tumor) because you didn’t know the difference. This is just one example of why it is essential for a person with a medical coding job to have a sound understanding of medical terminology, anatomy, physiology and pharmacology.

When you study in MTI College’s Medical Billing and Coding certification program, you learn the important skills you need to work as a healthcare professional – including the basics of anatomy and physiology. A requirement for a medical coding job is receiving an ICD-10-CM/PCS certification. Here’s why you need to have a basic medical background.

ICD-10 universally classifies and codes all diagnoses, symptoms and medical procedures. The International Classification of Diseases, Tenth Revision (ICD-10), is an organized way of telling the entire story of a patient’s care and encounter with a doctor and/or hospital. According to the World Health Organization, which created the ICD in 1948, it is the gold standard for reporting diseases and health conditions. The universally accepted codes that you, as a medical coder, use make it easy to share and compare patient medical information among various hospitals, regions and providers. They also ensure that the procedure that is billed makes sense with the diagnosis. For example, if you code a bee sting diagnosis as a justification for an x-ray, it’s likely the claim would be rejected. You don’t want a clerical error on your part to result in patient harm. If you indicate that a patient with a known allergy to penicillin received that drug for an infection rather than Bactrim, it could prove disastrous.

Various codes correspond to various bodily systems and procedural locations. You need to understand anatomy, physiology and pharmacology so that you can accurately enter the codes that apply to specific procedures, diagnoses and treatments. These codes are so highly detailed that they even indicate on which side of the body the procedure is being done. In addition, your understanding of basic anatomy and physiology will help you categorize the different bodily systems (e.g., respiratory, muscular, skeletal, circulatory, etc.) involved.

Medical coding is extremely specific. In addition to learning ICD-10 codes, you must know CPT® codes as well. The five-character Current Procedural Terminology codes are the U.S. standard for the way medical professionals document and report medical, surgical, laboratory, radiology, anesthesiology and E/M (evaluation and management) services. Some procedures are straightforward, but others can be confusing. Take a lipoma, for example. A lipoma’s depth into the tissues varies, but its coding depends on exactly where it is located. Coders need to not only know what a lipoma is, but also what the difference is between subcutaneous and intramuscular tissue, as well as the size of the excision to remove it.

Deciphering a doctor’s scribble is important.  When a doctor is writing patient notes, the coder needs to understand it. He or she is likely to be in a hurry and writes down a diagnosis, a treatment plan, a prescribed medicine and maybe a follow-up procedure. For someone doing medical coding, that needs to be transcribed into standard code to record the patient’s medical history and to submit it all to insurance for billing. If you misinterpret the notes or just don’t understand, it could cause confusion and delays in paying insurance claims, or even result in a denial of coverage.

Your medical coding expertise is essential to patient care. We live in a data-driven world, and that’s critically important in health care. Listing symptoms, diagnoses and procedures, and sending reports to an insurance company to request reimbursement, is not enough. Every time a person visits a doctor for an illness, for example, there are symptoms. They are recorded, along with the procedures performed and medicines prescribed. Maybe it’s a fever and sore throat. The doctor might order a strep test. If strep throat is the diagnosis, an antibiotic is generally prescribed. That’s rather straightforward. What if the patient sees the doctor because she is pregnant? She needs regular testing, ultrasounds, blood work, abdominal measurements, special vitamins, etc. Then what happens if there is a complication? More documentation is required. It gets very complicated, and your responsibility increases for accurately recording data that you first need to understand. You don’t want to mistake gestational diabetes for Type 2 diabetes, or preeclampsia for edema.

As a medical coder, you do not make diagnoses or treat patients, but you do need a basic understanding of anatomy, physiology and pharmacology to ensure that health information is documented accurately. Medical coders are in demand, and jobs are expected to rise much faster than average. MTI College offers the training you need to enter this high-growth field..

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