Medical Billing vs. Medical Coding: What’s the Difference?

Medical billing and medical coding go hand in hand, and are often performed by the same professionals. But although they work together as vital pieces in the business of health care, they are distinct professions with their own responsibilities.

Medical Coding: Translation

Medical coding is the process of using specific codes to identify medical procedures and services for billing and reimbursement by the patients’ insurance companies.

A medical coder reads the patient’s medical file — including medical history, current diagnosis, medicine prescribed and services performed — and assigns the appropriate code based on their coding knowledge. The codes are entered into the computer and are universally recognized by other health care professionals to accurately reflect the patient’s case. (See: medical coder job description.)

Medical Billing: Correspondence

Once the procedure and service codes are determined, the medical biller transmits the claim to the insurance company for payment. Medical billing is the process of submitting and following up on claims to insurance companies in order to receive payment for services rendered by a health care provider.

A medical biller ensures that the patient and health insurance company are properly billed for all procedures. Approved claims are reimbursed, while rejected claims are researched and amended. (See: medical biller job description.)

Since they work so closely, billers are also familiar with the medical codes that coders use in their job, and in smaller offices the same person may fill both functions.

Also see: medical billing and coding training, and how to start a medical billing business.