Outpatient surgical coders are primarily responsible for reviewing statements and assigning codes using classification systems to ensure that insurance companies are billed correctly for services issued by medical providers. They help facilitate a smooth billing process by checking doctors' notes, tests, images, and patients' medical records, and then assigning codes which represent every step of the patient's experience with the physician to confirm what services were provided. This coding must be completed with a great deal of precision to ensure that the medical provider is reimbursed for all services rendered, and outpatient surgical coders typically process many cases per day in an indoor office setting.
While this position differs from that of a surgical biller, the responsibilities of the two are closely related and they may occasionally work together, as thorough and effective cooperation between the coder and biller prevents denials of payment from insurance companies. Outpatient surgical coders must have in-depth knowledge of human anatomy, medical terminology, and the coding systems used in their company's codebooks, and they must also be aware of all relevant regulations, including which coding systems apply to private insurance plans, which apply to government plans, and how to comply with either.
Outpatient surgical coders must be well-versed in ICD-10 coding, as it became the standard medical coding system in the U.S. in October 2015, and they may also be responsible for auditing appeals and denied bills by insurance companies. This may involve reviewing the bill and/or educating the insurance company or medical provider about the appropriate details and coding.
Outpatient Surgical Coder Tasks
Coordinate with physicians to deliver accurate and timely documentation.
Ensure compliance with coding regulations and guidelines.
Ensure coding of outpatient charts and maintain electronic records.
Maintain coding skills in compliance with regulations.