Bob Biller is an aspiring health care student who is fascinated by the complex world of medical billing and coding. Since his childhood, Bob has been excited about working in the world of finance, accounting, billing, and coding. Today, he finally has that opportunity. However, Bob needs your help, as he does not completely understand how the process works. Are you willing to help? I thought you were. First, Bob has a couple of questions that he needs answered.

1. Are coding and billing the same thing?

2. Can Bob be a coder as well as a biller?

Okay, thank you for your help with the above. Bob is ready to roll. Now that Bob is finally on the job, he is hopeful that he has the appropriate background to undertake the task of being a coder. It is essential that Bob has a background in anatomy, medical terminology, financial concepts, and insurance plans; he must also understand the various compliance issues surrounding the profession. Medical coder education exists in many forms, so it depends on where an individual lives when it comes to requirements and opportunities. Some individuals learn on the job and others have degrees in the coding field. Furthermore, numerous certification programs exist to provide individuals the background and skills they need to become medical coders. Now that Bob has a thorough understanding of the skills necessary, he once again requests your help with the actual process. Bob knows that you are an expert in this area and wants to know:

1. What are ICD codes? Please explain where these codes come from and how they are used.

2. Are there codes other than ICD? If so, what might they be and what are they used for?

Thank you, your answers are a big help. Bob feels like he is ready to undertake his new position. He has a list of questions that he thinks will be helpful to him as he continues his career and he is hopeful that you will be able to answer them for him.

Bob thanks you in advance for researching this topic.

DISCUSSION QUESTIONS 

1. Who needs to understand the billing and coding process in health care and why?
2. Are there opportunities for fraud and abuse in the billing and coding professions? Explain.
3. What professional organizations certify coders? What are the requirements?
4. Explain how efficient billing and coding practices can reduce costs and allow an organization to receive payments in a timely manner.
5. Discuss some of the federal laws that mandate and control the medical billing and coding professions.