Being in the healthcare and insurance industries, it becomes paramount for you to be acquainted on how medical procedure codes are used. This had been in existent even before the computer age – in paper. But today, the ease and quickness of data processing using electronic means make medical procedure codes and billing even easier and faster.
A description of the medical procedure codes
These are codes specifically used by hospitals, doctors, nurses and all people involved in the healthcare industry. There is a code assigned for every diagnosis and treatment. The codes are used to prepare the patient’s billing statement. There is a universality in this system as these health care professionals use the same codes for identical illness, diagnosis and treatment.
The medical procedure codes are represented by number and alphanumeric characters composing the five-digit code. In the United States, the medical procedure codes were developed by the American Medical Association and this is standardized for uniformity in the billing and reimbursement of healthcare expenses. Old codes are removed from the list and new codes are substituted. Thus, beneficiaries who use these codes had to see to it that they are updated on the guidelines of the American Medical Association.
There are a lot of types of these codes, however, the insurance companies usually make use of three – the CPT, ICD and DRG
Medical procedure codes – CPT type
CPT is the acronym for Current Procedural Terminology. This describes whatever examination, diagnosis and treatment were done by the physician. The procedures included in the CPT medical procedure codes can be physical, medical and surgical. These codes have very important functions both for the patient and the insurance company. A code keeps the patient’s medical history so that the patient can review all the procedures done during his illness. To the insurance companies, it is the basis for payments or reimbursements of medical expenses.
The CPT medical procedure codes are too many despite the fact that the American Medical Association regularly updates the list whereby obsolete codes are removed. New codes are added to the list. Although Medicare also uses codes similar to the CPTs, their codes are known as HCPCS or Healthcare Common Procedure Coding System.
Medical procedure codes – ICD type
Another kind of medical procedure codes in the insurance industry if the ICD. This stands for International Statistical Classification of Diseases. A suffix such as ICD-9 or ICD-10 indicates the number of revisions. So – ICD-9 is the ninth revision of this type of procedure codes. These medical procedure codes are means to classify diseases on the basis of their symptoms, diagnosis, causes and social circumstance. Under the ICD, each health condition is categorized and assigned its unique code. The code ranges from 1 to 6 characters. And like other codes, the ICD provides a global uniform system for healthcare practitioners and insurance companies. When used with the CPT codes, ICD codes describe test procedures.
In the United States, these ICD medical procedure codes are governed by CDC and in the international arena – by the World Health Organization. The code may vary from time to time and you find these codes in patient’s hospital records as well as in death certificates.
Medical procedure codes – DRG type
A third type of common code is the Diagnosis Related Group or simply DRG codes. There are over 500 groups and the basis for the grouping of patients are age, diagnosis, treatment and some other related criteria. Patients with identical parameters are grouped together. Medicare makes use of the DRG codes for reimbursement purposes.
So – here are three most common medical procedure codes used in the healthcare and insurance industries. The codes had been very useful in these industries because of the universal uniformity in classifying reimbursable patient’s medical and hospital expenses.