All about CPT and ICD codes in medical billing

All about CPT and ICD codes in medical billing

If you decide to venture into the field of medical coding and billing, your role will be to transcribe medical information into shortcodes for the ease of patients and health insurance companies. This means it is essential to understand more about the medical coding systems that exist. There are several medical coding and billing programs that disseminate information about these practices, but let’s delve deeper to know more.

Before we speak about the specific codes that are integral to medical coding and billing programs, we need to touch upon medical coding systems and why they exist. 

What Are Medical Coding Systems?

As per the American Academy of Professional Coders (AAPC), medical coding is the transformation of healthcare diagnoses, procedures, medical services, and equipment into universal medical alphanumeric codes. The diagnoses and procedure codes are taken from medical record documentation, such as transcription of physician’s notes, laboratory, and radiological results.

Medical coding classification systems are a set of codes that correspond to individual procedures and diagnoses. These codes help to evaluate and track all the information about diseases and health conditions from a patient’s record.

The Different Types Of Coding Systems 

Any credible medical coding and billing program will introduce you to five types of coding classification systems. These coding systems are not just used in healthcare facilities or hospitals; even government health programs and insurance companies rely on them.

  • ICD-11

This is the latest set of codes of the International Classification of Diseases (ICD) that was released in January 2022. These codes aim to classify everything from diseases to symptoms. Interestingly, these sets of codes have under their purview expanded definitions for sexual health, and new entries for the immune system.

  • ICD-10-CM

This version is a clinical modification of the previous version of ICD, ICD-10. These codes are generally utilized in a clinical setting and are far more detailed than others. They are particularly helpful in the case of clinical, and outpatient applications, since they also allow for clarification of the severity of a disease.

  • ICD-10-PCS

Another version of ICD-10, although this is a procedural one. It is used for a more detailed classification of diseases and conditions, and is largely used in in-patient settings.

  • CPT

CPT stands for Current Procedural Terminology and its relevance lies in reporting diagnostic, surgical, and medical procedures. This system is helpful in identifying the various procedures that doctors and other healthcare professionals perform for their patients.

  • HCPCS Level 2

Also known as the Healthcare Common Procedure Coding System Level 2, HCPCS is based on CPT. This coding system helps to code non-physician services that otherwise do not fall under CPT. These may include ambulances, drugs, and prosthetics.

CPT And ICD In Medical Billing 

When you are billing for healthcare services, both CPT and ICD codes come in handy. CPT refers to the treatment that is being administered, while ICD codes denote the problem that the treatment is aiming to resolve. The two systems work in line with each other.

Speaking about CPT codes, most healthcare facilities use the five-digit codes that fall under Category I. There are Category II and Category III codes that are used to gather information about the quality of care, and newer procedures respectively.

On the other hand, ICD codes that have been developed by the World Health Organization are the standard diagnostic codes that are often used by healthcare providers and researchers, as well as public health officials.

Partnering With ScribeEMR

ScribeEMR has a dedicated team of medical billers and coders, ensuring that payments are received from insurers within the stipulated time period. Any sort of medical coding issue generally leads to delayed reimbursements, federal penalties, intense scrutiny, and more.

At ScribeEMR, medical coders and other professionals are trained to analyze and translate medical charts and assign the right codes that correspond to each type of visit, diagnoses, or treatment. Reap the benefits of improved medical billing, increased revenue, as well as fewer claim rejections.

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