Medical Billing & Coding Connection

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The Three Main Medical Billing Codes

medical billing code

Regardless of whether you choose to work as a biller or coder, there are three primary sets of medical billing codes that you’ll need to become familiar with. While there are additional categories, and sub-categories within each system, all medical billing and coding is fundamentally based on the ICD-9 (soon to be replaced with ICD-10), CPT or HCPCS Level II code sets. We take a brief look at each of them in the following post.

The Three Medical Billing Codes Systems

International Classification of Diseases, 9th Revision (ICD-9)

Consisting of over 17,000 different codes, the ICD-9, or ICD-9-CM (clinically modified) system has been used to classify diseases and medical conditions around the world since 1979. Its origins go back much further, however, as the first version of the ICD system was introduced in Europe in 1893.

Originally developed by the WHO (World Health Organization), the system has been the mandatory medical billing code for U.S. health care and insurance providers since 2003.

How ICD-9 CM Works

The ICD-9 CM system is made-up of three volumes of medical billing codes, each of which are used to classify a particular aspect of a patient’s condition and billable services he or she received. The contents of the three volumes break down as follows:

Volume One

The first volume of the ICD-9 CM system contains numeric listings, broken down by anatomical and etiological systems, for a wide range of diseases and conditions. Its use is mandatory at all health care facilities.

Volume Two

The system’s second volume consists of an alphabetic index used to help billers and coders locate the disease or condition code referenced in Volume One. Its use is also mandatory.

Volume Three

The third volume of ICD-9 CM contains a tabular section and index that are used to classify procedures performed during a patient’s stay at a hospital. As such, it is only used by hospitals when they are reporting services rendered.

The Future of ICD-9 CM

Beginning on October 1, 2014, the ICD-9 CM system will be retired in favor of the new set of ICD-10 CM medical billing codes. Whereas the ninth version of the system featured only 17,000 unique codes, the long-awaited 10th edition will feature over 141,000.

ICD-10

Current Procedural Terminology (CPT)

The CPT coding system is made-up of five-character, alphanumeric codes used to specifically describe a wide range of services that may be provided by a health care provider. Introduced by the AMA in 1966, its primary purpose is to help the provider procure timely, accurate reimbursement from insurance companies and other payers.

There are three categories of CPT codes. A brief description of each follows:

Category I

The first category of CPT codes deals with only the five-number identifier assigned to a service or procedure. The numeric code is accompanied by a descriptive, coded nomenclature as well.

Category II

The second category of codes is optional and is mainly used to track performance.

Category III

The final category of CPT billing codes are used for any type of new procedure or service that falls outside those identified under Category I.

Who Uses CPT?

As mentioned, CPT is vital to all health care providers as it is used to assure accurate reimbursement for services from insurance providers and patients. Keeping this process running smoothly requires that both parties employ medical billing specialists who are fluent in both the code and its associated nomenclature.

Healthcare Common Procedure Coding System (HCPCS)

medical coding codesThe third of the primary medical billing codes used throughout the healthcare industry is HCPCS. Unlike ICD-9 CM and CPT, this coding system is used for a wide range of needs instead of just certain billing processes. Its most-common usage, however, is for standardizing the filing of claims with insurance companies (Medicare, in particular).

Another difference between HCPCS and the other code sets is that, instead of being static, it is updated quarterly to reflect requests made by users.  Its evolving, flexible nature makes HCPCS highly popular with an organization that employs new technologies or those in development.

Which Medical Billing Codes Should You Learn?

Assuming that you pursue your medical billing certification through an accredited program, you will most likely be exposed to all three of the systems mentioned above. While it is considered mandatory to learn ICD-9 CM and CPT, and you should therefore expect to spend a considerable amount of time studying them, learning HCPCS may be offered as an option.

Deciding which of these medical billing codes assuming that you pursue your medical billing certification through an accredited program, you will most likely be exposed to all three of the systems mentioned above. While it is considered mandatory to learn ICD-9 CM and CPT, and you should therefore expect to spend a considerable amount of time studying them, learning HCPCS may be offered as an option.

Deciding which of these medical billing codes you should learn depends a great deal upon the area of medical billing and coding where you want to work. Let your desired career path (e.g. working as a billing specialist in a private practice, hospital, insurance company, etc.) be your guide to deciding where to emphasize your efforts.

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