Learn the Different Types of Medical Codes that Dictate What Your Practice Collects
There are several types of medical codes used for very different purposes, but they all result in you getting paid for healthcare services provided.
Learn what these medical codes are and how they affect medical billing and what you get paid.
ICD-10 Diagnosis Codes
Diagnosis medical codes are vital to describing a patient’s health condition or injury, plus social determinants of health and other patient characteristics. The International Statistical Classification of Diseases and Related Health Problems Tenth Revision (ICD-10) is used by the industry to determine diagnosis codes for medical billing.
There are two types of medical codes within the ICD-10:
- ICD-10-CM – Clinical modification codes for diagnostic coding
- ICD-10-PCS – Procedure coding system for inpatient procedures performed in hospital
In just the ICD-10-CM code set there are over 70,000 unique identifiers. The World Health Organization sets and maintains the ICD coding system and it is used internationally.
These types of medical codes assist medical billing by explaining why the patient sought medical attention and the severity of their injury or condition.
Charge Capture Codes
Medical coders connect physician order entries, patient care services and other clinical items with a chargemaster code. A Chargemaster is a list of the practice’s prices for each service they offer. This process is known as “charge capture.”
A Revenue Cycle Manager will use these prices to negotiate claims reimbursement rates with payers (insurance companies) and bill patients what they owe.
HCPCS and CPT Procedure Codes
An important part of medical coding is to convey what the healthcare provider did during an appointment. Procedure codes accompany diagnosis codes by providing this information.
There are two main procedure medical coding systems:
- Current Procedural Terminology (CPT)
- Healthcare Common Procedure Coding System (HCPCS)
The CPT coding system is used to explain the services provided to a patient during an appointment to private payers. This coding system is managed by the American Medical Association. Procedure codes explain what happened and why.
CPT modifiers explain if there were multiple procedures, why a provided service was medically necessary, and what portion of the body was addressed. CPT modifiers are important, because it’s how your practice is correctly reimbursed for all services provided.
Private payers use CPT codes, but CMS and other third-party payers may require you to submit claims with HCPCS codes. HCPCS codes can describe non-physician services like ambulance rides, prescription drug use or durable medical equipment use.
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Professional and Facility Codes
Your medical records also need to be translated into professional and facility codes. Professional codes translate physician and clinical services rendered into a code for billing purposes.
Facility codes are used by hospitals to account for the cost of overhead. Facility codes capture charges for things like using space, supplies, equipment and other technical components of care.
Medical Coding Services
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