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What does a Clinical Coder do?

Bobbie Fredericks
Bobbie Fredericks

A clinical coder codes procedures done and diagnoses made in order to properly bill the patient's medical insurance. The codes are found in several large manuals, and the coder must determine from the medical record which codes to assign. Clinical codes are also used to compile statistics, such as morbidity and mortality.

The clinical coder must have a firm grasp of medical terminology, anatomy, and physiology, as well as a working knowledge of diseases, conditions, and treatments. These will all help in finding the correct code. If the clinical coder makes a mistake, the patient's insurance claim could be rejected or statistics could come out wrong. This requires the coder to have strong analytical skills and attention to detail.

A clinical coder ensures the proper medical billing.
A clinical coder ensures the proper medical billing.

Every procedure performed has a code assigned to it, called a Current Procedural Terminology (CPT) code. The clinical coder must decide which CPT code to use. Each CPT code also has an assigned International Classification of Diseases (ICD) code, which relates to the diagnosis. The CPT code must be found first, or the final coding will come out wrong.

The kinds of codes used will vary by the type of facility the clinical coder is working for. Facilities where a clinical coder might work include doctors' offices, nursing homes, hospitals, and insurance companies. Clinical coders that work for insurance companies verify the codes submitted on patient insurance forms.

Coders must also have people skills. While most of the work of a coder is done alone at a desk, it might sometimes be necessary to clarify details with a health care provider. Sometimes, an insurance company will call to have the coder verify the codes submitted. Coders who work for insurance companies may need to call coders at other facilities to verify submitted codes.

There are six different certification exams clinical coders can take. Some can be taken right after the coding eduction is complete, and some require at least one year of work experience in the field. The two organizations in the United States that offer certification are the American Health Information Management Association and the American Academy of Professional Coders. Some certifications are based on the type of facility the coder wishes to work for.

Clinical coder training is usually either a one year diploma or a two year associate's degree. Some programs may even be shorter. There are both online and on-campus options available for coding students. Both the college and medical coding program should be accredited in order for the student to become a certified clinical coder.

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    • A clinical coder ensures the proper medical billing.
      By: Lisa F. Young
      A clinical coder ensures the proper medical billing.