Medical Codes — 3 Things You Need To Know

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Medical codes are used to describe diagnoses and treatments, determine costs and reimbursements, and relate one disease or drug to another.

Patients can use medical codes to learn more about their diagnosis, learn more about the services their practitioner has provided, figure out how much their providers were paid, or even to double check their billing from either their providers or their insurance or payer.

Source: http://patients.about.com/od/medicalcodes/tp/medicalcodeshub.htm

Here are a few things you need to know about medical codes along with links to insightful resources!

CPT Codes — Current Procedural Terminology Codes

These codes, developed by the American Medical Association, describe every type of service a healthcare provider may provide to a patient. They are used to make a list of those services, then to submit to insurance or Medicare or another payer for reimbursement purposes.

Patients may be interested in looking at CPT codes to better understand the services their doctor provided, to double check their bills or negotiate lower pricing for their healthcare services.

Source: http://patients.about.com/od/medicalcodes/tp/medicalcodeshub.htm

Additional Resource:

CPT Codes vs. HCPCS Codes — VIDEO

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ICD Codes — International Classification of Diseases Codes

ICD is used by physicians, nurses, other providers, researchers, health information managers and coders, health information technology workers, policy-makers, insurers and patient organizations to classify diseases and other health problems recorded on many types of health and vital records, including death certificates and health records.

In addition to enabling the storage and retrieval of diagnostic information for clinical, epidemiological and quality purposes, these records also provide the basis for the compilation of national mortality and morbidity statistics by WHO Member States. Finally, ICD is used for reimbursement and resource allocation decision-making by countries.

There are two related classifications of diseases with similar titles, and a third classification on functioning and disability. Source: http://www.cdc.gov/nchs/icd.htm

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HCPCS Codes – Healthcare Common Procedure Coding System

The HCPCS is divided into two principal subsystems, referred to as level I and level II of the HCPCS.  HCPCS Codes are used by Medicare and are based on CPT Codes. Level I of the HCPCS, the CPT codes, does not include codes needed to separately report medical items or services that are regularly billed by suppliers other than physicians.

Level II of the HCPCS is a standardized coding system that is used primarily to identify products, supplies, and services not included in the CPT codes, such as ambulance services and durable medical equipment, prosthetics, orthotics, and supplies (DMEPOS) when used outside a physician’s office. Because Medicare and other insurers cover a variety of services, supplies, and equipment that are not identified by CPT codes, the level II HCPCS codes were established for submitting claims for these items. The development and use of level II of the HCPCS began in the 1980’s. Level II codes are also referred to as alpha-numeric codes because they consist of a single alphabetical letter followed by 4 numeric digits, while CPT codes are identified using 5 numeric digits. Source: https://www.cms.gov/Medicare/Coding/MedHCPCSGenInfo/index.html?redirect=/MEDHCPCSGenInfo/

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