In order to receive reimbursement for services provided to patients, health care providers must submit a billing claim to the insurance payer. Information is compiled for the claim through codes and then the claim is submitted to the payer.

Understanding Coding

Coding is the process of assigning numeric and alphanumeric code sets to the descriptions of a patient's medical conditions, surgeries and other treatments.

Understanding Billing

Billing is the process of organizing the numeric and alphanumeric codes onto a claim form and then submitting the billing claim to the insurance for reimbursement.

Coding and Documentation

Without the appropriate documentation and explanation of the patient's medical care, codes cannot be assigned. Coding documentation supports a medical bill by simplifying long narrative explanations into numerical and alphanumerical codes.

Billing and Documentation

Coding documentation helps to insure that the appropriate services are reflected on the medical bill. The codes documented alert both the billing department and the insurance payer as to the reimbursement amount.

Importance of Documentation in Coding and Billing

Documentation is important in both coding and billing because it helps to insure integrity by providing supportive documentation for the information reported. In addition, coding documentation assists with any issues that may arise with billing, such as the need for a claims denial appeal.

Source:

American Health Information Management Association (AHIMA): Coding

Understanding Health Insurance: A Guide to Professional Billing; JoAnn C. Rowell and Michelle A. Green; 2001

More Information:

American Academy of Professional Coders

American Medical Billing Association