How to Be Physician Coder - Job Description, Skills, and Interview Questions

When a physician coder is not well-versed in medical coding, it can have a ripple effect throughout a healthcare organization. Poor coding accuracy can lead to costly denials and delays in payment, resulting in financial losses that can be detrimental to the organization. On the other hand, having a highly skilled physician coder on staff can result in accurate coding, improved reimbursement, and overall financial stability.

This can lead to better patient care, as well as improved morale among staff members. having a competent physician coder is essential for the success of any healthcare organization.

Steps How to Become

1. Obtain a postsecondary degree in medical coding or a related field. A degree in health information management, medical office administration, or a related field is necessary for a career in physician coding.
2. Earn a certification from a recognized industry organization. The American Health Information Management Association (AHIMA) offers two certifications for physician coders. the Certified Coding Specialist-Physician-based (CCS-P) and the Certified Professional Coder-Physician-based (CPC-P).
3. Gain experience in the medical coding field. After achieving certification, obtaining experience in physician coding is essential in order to become a successful coder. Working as a medical coding intern or volunteering in a hospital setting can give you the hands-on experience you need to be successful.
4. Become familiar with coding software. Many hospitals and medical practices use software programs to track patient information and assign codes for billing purposes. Familiarizing yourself with the most popular coding software programs will give you an edge when looking for a physician coding job.
5. Join professional organizations. Becoming involved with industry organizations like the American Academy of Professional Coders (AAPC) and the American Health Information Management Association (AHIMA) can help you stay up to date on changes in the physician coding field and provide networking opportunities.

As the health care industry continues to evolve, the role of a physician coder has become increasingly important. To stay ahead and remain qualified in this field, it is essential to stay up-to-date on coding changes, understand coding guidelines and regulations, and maintain certification. Keeping current with the ever-changing requirements of the industry is critical to ensuring accuracy and compliance.

Further, developing a specialty, such as working with a specific type of patient or condition, can also help to increase coding knowledge and skills. staying ahead and qualified as a physician coder requires dedication to ongoing education, self-improvement, and professional development.

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Job Description

1. Physician Coder €“ reviews medical records and assigns codes for diagnoses and procedures according to established coding guidelines. Utilizes software applications and/or coding resources to accurately assign codes. Verifies accuracy of coding and submits coding for payment.
2. Coding Quality Auditor €“ reviews medical records and assigned codes for accuracy and completeness according to established guidelines. Identifies any discrepancies and follows up with the coder to ensure accuracy.
3. Coding Compliance Analyst €“ evaluates coding compliance and accuracy according to established guidelines. Develops corrective action plans and implements changes to ensure compliance with regulations and guidelines.
4. Coding Educator €“ provides education and training to healthcare providers on coding practices, guidelines, regulations, and technology. Monitors coding accuracy and provides feedback to improve coding performance.
5. Coding System Administrator €“ maintains and updates the coding system, including assigning user access rights and security levels. Monitors system performance and resolves any technical issues that may arise.

Skills and Competencies to Have

1. Knowledge of medical terminology
2. Knowledge of anatomy
3. Knowledge of physiology
4. Understanding of health care reimbursement systems
5. Familiarity with ICD-10, CPT, and HCPCS coding systems
6. Ability to interpret doctor€™s notes, lab results, and other medical records
7. Proficiency in data entry and accuracy
8. Ability to research coding issues and to apply coding guidelines
9. Ability to interpret insurance coverage guidelines
10. Detail oriented with strong organizational skills
11. Excellent communication skills
12. Understanding of HIPAA regulations and privacy requirements

Physician coders are essential members of the healthcare team and their role in the medical field is pivotal. The most important skill a physician coder must possess is a strong knowledge of the coding system. This includes the ability to accurately assign codes to diagnoses and procedures, as well as a fundamental understanding of the coding process and the regulations that govern it.

Without a thorough understanding of the coding system, physician coders will not be able to accurately code medical records and claims, which can have serious consequences for both the provider and the patient. Furthermore, physician coders must ensure accuracy and completeness of coding, which requires an in-depth comprehension of medical terminology, anatomy, and physiology. They must also stay up to date on coding changes and regulations to ensure compliance and accuracy.

this skill set is critical for physicians to provide quality patient care and be successful in their career.

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Frequent Interview Questions

• How do you stay up to date on insurance coding changes?
• What experience do you have coding medical diagnoses and procedures?
• What is your experience with ICD-10?
• How do you ensure accuracy when coding medical documentation?
• How well do you understand the anatomy and physiology of various medical conditions?
• Do you have experience using computerized coding systems?
• What is your experience with using billing software programs?
• How do you ensure compliance with all applicable coding regulations?
• What strategies do you use to identify and correct coding errors?
• How do you collaborate with physicians to ensure accurate coding of medical documentation?

Common Tools in Industry

1. CPT Coding Books. A comprehensive reference book that provides the latest codes and descriptions for medical services and procedures. (eg: CPT 2020 Professional Edition)
2. ICD-10-CM Diagnostic Code Books. A reference book that provides the latest codes and descriptions for diagnosing diseases, illnesses, and injuries. (eg: ICD-10-CM 2020: The Complete Official Codebook)
3. Computer-Assisted Coding (CAC) Software. Automated software that helps coders quickly and accurately assign codes to medical services and procedures. (eg: 3M Coding and Reimbursement System)
4. Encoder Software. Software that quickly searches and finds coding information based on specific medical services and procedures. (eg: Optum360 EncoderPro Expert)
5. Coding Compliance Auditing Software. Automated software that helps ensure coding accuracy, completeness, and compliance with federal regulations. (eg: Ingenix Coding Compliance Auditor)
6. Charge Capture Software. Automated software that helps capture all the charges associated with a patient's visit to ensure billing accuracy. (eg: DrChrono Charge Capture)

Professional Organizations to Know

1. American Academy of Professional Coders (AAPC)
2. American Health Information Management Association (AHIMA)
3. American Medical Association (AMA)
4. International Classification of Diseases (ICD)
5. The Centers for Medicare & Medicaid Services (CMS)
6. National Uniform Billing Committee (NUBC)
7. American Medical Billing Association (AMBA)
8. Healthcare Information and Management Systems Society (HIMSS)
9. National Center for Health Statistics (NCHS)
10. National Correct Coding Initiative (NCCI)

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Common Important Terms

1. ICD-10-CM. International Classification of Diseases, 10th Revision, Clinical Modification. This is a medical coding system used to classify medical diagnoses and inpatient procedures by code.
2. CPT. Current Procedural Terminology. This is a coding system for services and procedures performed by health care providers.
3. HCPCS. Health Care Common Procedure Coding System. This is a coding system for medical supplies, equipment, and services not found in CPT.
4. DRG. Diagnosis-related Group. This is a system used to classify hospital inpatient stays into categories based on diagnosis, procedure, age, gender, and discharge status.
5. APC. Ambulatory Payment Classification. This is a system used to classify outpatient services and procedures into groups based on clinical similarity, intensity, and cost.
6. MS-DRG. Medicare Severity Diagnosis-related Group. This is a system used to classify hospital inpatient services and procedures into categories based on diagnosis, procedure, age, gender, and discharge status for Medicare patients.
7. E/M. Evaluation and Management. This is a coding system used to assign codes for office visits, inpatient visits, and other types of visits.

Frequently Asked Questions

What is a Physician Coder?

A physician coder is a professional who specializes in coding diagnosis and procedures for medical claims. They utilize coding systems such as ICD-10 and CPT to ensure accuracy and compliance with insurance payers and government regulations.

What skills are needed to be a Physician Coder?

Physician coders need to have a solid understanding of anatomy, physiology, and medical terminology in order to accurately code diagnoses and procedures. They also need to be skilled in using coding systems such as ICD-10 and CPT and familiar with relevant insurance payer policies and government regulations.

How much does a Physician Coder make?

According to the Bureau of Labor Statistics, the median annual wage for medical records and health information technicians, including physician coders, was $41,460 in May 2019.

How long does it take to become a Physician Coder?

The amount of time it takes to become a physician coder varies depending on the individual. Generally, it takes between one to two years to complete the necessary training, which includes courses in medical terminology, anatomy, physiology, and coding systems such as ICD-10 and CPT.

What organizations offer certification for Physician Coders?

Several organizations offer certification for physician coders, including the American Academy of Professional Coders (AAPC), the American Health Information Management Association (AHIMA), and the American Medical Billing Association (AMBA).

What are jobs related with Physician Coder?

• Physician Quality Improvement Coordinator
• Physician Recruiter
• Physician Office Manager
• Physician Consultant
• Physician Compliance Officer
• Physician Executive
• Physician Scheduler
• Physician Assistant
• Physician Network Administrator

Web Resources

• Physician Professional Coder €” Cecil College www.cecil.edu
• Physician Office Coding and Billing, Certificate - College of DuPage catalog.cod.edu
• Physician Role | Center for Health Interprofessional €¦ healthipe.utexas.edu