Medical Billing vs Coding: Key Differences Explained

If you're researching the difference between medical billing and coding, here's the short version: coding happens first, billing happens second. A medical coder reviews clinical documentation from a patient visit and assigns standardized diagnosis and procedure codes. A medical biller takes those codes, builds an insurance claim, submits it, and follows up until the provider gets paid.

Job postings often list "medical billing and coding" as one role, and in many smaller practices it is. One person handles the full revenue cycle from code assignment through payment posting. Larger hospitals and third-party billing companies split these into separate positions with different daily responsibilities and skill sets.

Medical coders read physician notes, operative reports, lab results, and other clinical records from patient encounters. They translate this information into standardized codes using three main systems:

• ICD-10-CM (International Classification of Diseases) -- over 72,000 diagnosis codes covering every documented condition
• CPT (Current Procedural Terminology) -- procedure and service codes maintained by the American Medical Association
• HCPCS Level II -- codes for supplies, equipment, and services not covered by CPT

The codes a coder assigns determine how much the provider gets reimbursed. Wrong codes lead to claim denials, underpayments, or compliance violations. Coders need a solid understanding of anatomy, medical terminology, and the clinical context behind what they're reading. Most coding work is independent and computer-based, which is why remote positions are common -- AAPC's 2025 survey reports that 64.8% of coders work from home.

Medical billers manage the financial side of the revenue cycle. After a coder assigns codes to a patient encounter, the biller creates a claim -- a standardized form (CMS-1500 for physician services, UB-04 for hospitals) -- and submits it to the patient's insurance company.

The job doesn't end with submission. Billers track claims through adjudication, follow up on unpaid or denied claims, handle appeals, post payments, and manage patient billing for remaining balances. This process is called accounts receivable (A/R) management or revenue cycle management (RCM).

Billers need to understand insurance contracts, payer-specific rules, coordination of benefits, and patient financial responsibility (copays, deductibles, coinsurance). They also verify insurance eligibility before services happen. Compared to coding, billing involves more people interaction -- with insurance reps, patients, and clinical staff.

Shared skills: Medical terminology, anatomy and physiology basics, HIPAA compliance, attention to detail, EHR proficiency, and the ability to work independently. Both roles require you to be comfortable working at a computer for extended periods.

Coding-specific: Analytical thinking for interpreting clinical documentation. Deep knowledge of ICD-10-CM, CPT, and HCPCS code sets. Ability to navigate code books quickly (the open-book CPC exam tests this directly). Understanding of coding guidelines across different medical specialties.

Billing-specific: Communication skills for working with insurance reps and patients. Knowledge of claim submission processes and payer rules. A/R management. Familiarity with clearinghouse systems for electronic claims. Problem-solving for denied or rejected claims.

The Bureau of Labor Statistics groups both medical billers and coders under Medical Records Specialists (SOC 29-2072), reporting a median salary of $50,250 per year as of May 2024. That makes it hard to isolate salary differences from federal data alone. For role-specific numbers, AAPC's 2025 Salary Survey is the best source.

AAPC reports that CPC-certified coders earn a median of $58,895 per year, while CPB-certified billers earn a median of $56,981. Professionals holding three or more certifications average $84,414 -- regardless of whether they started in billing or coding. The highest earners tend to be specialized coders in hospital inpatient coding, risk adjustment (HCC), or coding auditing, where salaries range from $70,000 to $85,000+.

For billing professionals, the strongest earning potential is in revenue cycle management. RCM managers who oversee billing departments can earn $65,000 to $90,000+ depending on the organization's size. See our salary guide for state-level data.

Most medical billing and coding programs cover both disciplines in a single curriculum. You'll learn coding systems (ICD-10-CM, CPT, HCPCS) alongside billing processes (claims, A/R, insurance verification). After completing a combined program, you choose which certification to pursue first based on what you enjoyed more.

Many professionals start in combined billing and coding roles, then specialize after a year or two of work experience. The training overlap is significant enough that switching between billing and coding later in your career is straightforward -- it usually means adding a new certification rather than starting over. Certificate programs cost $1,000 to $5,000 and take 4 to 15 months.