The preparation of the claim causes the overlapping of the functions of medical billing and medical coding. On one hand, it is the function of the medical billers to follow and use the procedures and corresponding codes used by medical coders. On the other hand, the billers are responsible for providing the correct procedure and diagnosis codes. These codes will be used for the creation of the claims.
The procedure codes will then tell the insurance company which services the healthcare providers have performed. Other codes such as the ICD codes for diagnosis reflect the medical necessity. To put it simply, the procedure codes contain the “what” of the patient’s visit; while the diagnosis codes tell the “why” of the patient’s visit. It is up to the medical biller to add information regarding the patient and the patient’s visit, including the expenses of the procedure.