3 Types and Basic Features of Medical Procedure Codes

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

medical procedure codes
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.

Unveiling the History, Uses and Types of Medical Procedure Codes

Medical procedure codes are codes used by doctors and other medical professionals to classify processes or services rendered to their patients. These codes are normally expressed in numbers or letters of the alphabet. The main function of the medical procedure codes is to furnish the patient with a straightforward billing statement. You can consider the use of the medical procedure codes as a way to provide a uniform billing language. This further makes it easier for insurance companies to institute reimbursement of client’s expenses on services of medical professionals. Although different insurers use different billing codes and guidelines, the uniformity is present because each of practicing physicians follow a specific alphanumeric code for every diagnosis.

How medical procedure codes evolve

It is interesting find out how the use of medical procedure codes came about. The roots of medical coding started as early as the 1900s. It started when codes were standardized and every standardized code referred to specific diseases, procedures, diagnoses and treatments of patients. This was initially done on paper but with the advent of computers, medical procedure codes and coding were computerized. This saved money and time in preparing the billing. There were medical billing software that helped in facilitating the task. Transfer of files and updates became automatic. Today, the medical procedure codes are utilized by all doctors and these codes are updated annually in order to ensure and safeguard that every possible diagnosis and condition are given their respective codes. If you are in this industry, you will realize that new codes are created and obsolete codes are discarded. As a part of the uniform practice, the task of coding is done by the American Medical Association (AMA). The agency issues software and guide materials in order for health professionals to keep abreast with current medical procedure codes.

The uses of medical procedure codes

medical procedure codes For their own personal use, hospitals and physicians use their own personal codes. However, they use a specific system for billing purposes. When a patient sees his doctor, he is examined for diagnosis and possible treatment. The resulting information from the process is recorded and inputted in the patient’s chart. Each patient has his own chart and is forwarded to the billing technician. The billing process is done and the coding of the data in the chart is handled by the billing technician. The bases of the assigned code are the medical needs of the patient, difficulty of the procedure done by the doctor and the treatment. After the code is assigned, the billing statement is forwarded to the patient’s insurer for payment. The insurance company bases its payment on the patient’s condition, procedures and treatments.

Common medical procedure codes

There are three types of medical procedure codes used by insurance companies, namely: • CPT or current procedural terminology code – This aims to describe the medical, diagnostic and surgical services rendered to the patient. This is a five-digit code. • ICD-9 or international classification of diseases code – This code describes the symptoms and signs, injuries, kind of disease and patient’s condition. • DRG or diagnosis related group code – This is a description of the inpatient services done to the patient while confined in the hospital. Although there still exist paper billing statements, the majority is electronically done. The medical procedure codes and billing used by insurance companies are uniform so the patient does not have to worry about billing differences. This will eliminate confusion. It is also good to note that the American Medical Association is not remiss in its job pertinent to the medical procedure codes. The AMA derives undisclosed but significant amount of income from this.

The Reason why Medical Procedure Codes are Useful

The health sector is a very busy one. Every day lots of people come for routine exams, surgeries, treatments etc. This means that in all the chaos, there must be a system that can be used to identify all the above without too much time wastage. That is where codes come in.
There are is a system that has been in place for years which consist of alpha- numeric codes which represent diseases, medical conditions, treatment methods as well as other services in the health sector.

Medical procedure codes are used in many places

The system of coding is used in many places and establishments. This is because it is a very good method of recording a patient’s health status, treatment methods used as well as drugs prescribed.
Because the coding system is widespread, any doctor or health care provider can look at a patients file and understand the medical history of that patient.
Patients can also use these codes to identify their medical condition, what the treatment procedure was as well as the cost that was incurred during the process.

Medical procedure codes make billing easier

medical procedure codes
When medical procedure codes are used, each code has its own standard payment. Therefore, when a patient comes for treatment, all the medical procedure codes that apply are written in the billing sheet and passed on to the insurance company for payment claims.
Therefore, each medical procedure is noted down and paid for by the insurance company. This means that, accurate codes must be used because if the diagnosis code does not match the treatment code then payment will not be issued to the health provider. That is why billing must be done very carefully to avoid such situations.

Medical procedure codes are updated

Because new diseases and medical conditions surface every year, medical codes are also updated in order to accommodate all new changes. This therefore means that there are a lot of codes currently and these codes are expected to grow as science discovers more medical conditions, ailments, treatment methods and medicines.
In health care facilities, there are people who are specially trained in coding and billing. These people make sure that all the new codes are added to the database of their respective health care facilities. They also make sure that they are abreast with all the latest codes that come out.
This ensures that the relevant codes are available during billing in order for payment to be made to such establishments.
This means that coding can sometimes get a bit technical if a patient has a disorder that is not identified or if there are multiple health problems with a patient. In this case, coding professionals use modifiers in order to explain the situation to insurance companies. If modifiers are not used, then there is a high chance that payment will not be issued by the insurance company.

An Overview of Medical Procedure Codes

The health care sector has its own coding system that is used to denote various diseases, medical conditions, procedures, drugs and treatment methods. These codes come in alpha-numeric format with varying digits according to their respective types.
Because there are countless diseases, medical conditions, medical procedures and treatment methods available, remembering all of them can become tiring and confusing. That’s why these codes were developed.

How medical procedure codes work

There are thousands of medical procedure codes available. Every year, more codes are added and therefore the list keeps on growing to accommodate newer medical conditions, modes of treatments and services.
When a patient receives treatment or any kind of medical service, all the relevant codes that correspond to the medical process involved are written in the records and billing sheet. Through this, payment can then be claimed from the insurance company in charge of paying the patient bills.
These codes are available to health care providers, doctors, insurance companies as well as patients for reference. Therefore, if any one wants to check what a certain code stands for or which kind of service was provided, all this takes is to track down what the particular code stands for in the available code database.

Importance of medical procedure codes

medical procedure codes
Medical procedure codes are very important and hence many people in the health sector rely on them for keeping records and creating bills.
If there were no specific codes then there would have been no standard of payment and this would have resulted in a lot of problems between the health care providers and the insurance companies in charge of releasing payments to these establishments
Medical procedure codes are universally acknowledged and understood by more than a 100 countries worldwide. Therefore, any hospital or physician can take a look at the records of a patient and can easily understand what these codes stand for. This ensures that a person can avail treatment from any medical facility that implements the coding system.

How medical procedure codes are implemented in health care facilities

In establishments that provide health care services, there are many ways by which the medical procedure codes are implemented effectively every day throughout these facilities.
Some facilities make use of a software program that contains all the codes and does the billing. This software is specially designed to understand and supply all the required codes as well as any other information that might be required during billing.
Other facilities have departments that are solely established for the purpose of coding and bailing the patients who receive treatment there. Because this department is located on the premises, it makes it easier for the billing and coding to be done quickly and more accurately.
Another method is that some facilities hire professional coders to do all their coding and billing. These people therefore work outside the premises of the health care facility and do not come in contact with the patients.

Understanding Medical Procedure Codes

Medical procedure codes are a system of alpha-numeric characters that used by various health facilities around the world. These codes are very useful; therefore they are carefully compiled and updated as time goes by.

How medical procedure codes are used

Medical procedure codes are used on patients’ reports, bills and sometimes on death certificates. Each code is unique and is used to identify a medical procedure. A diagnosis code is first identified for a particular patient after a checkup. After treatment, the code that is related to the specific treatment is then written in the patient’s report, records and billing sheet.
After this, then the payment that corresponds to the particular procedure code or codes is then calculated. This is how hospitals charge patients or the insurance companies in charge of the medical bills of these patients.
Most of the billing and coding information can be done by a special software program at small health care facilities or by a group of trained billing and coding experts who work in the billing and coding sections of larger establishments.
Other healthcare facilities hire people outside their premises to handle all their billing and coding work. In any of the above methods, the most important thing is that the coding must be done accurately and carefully in order to avoid error and problems in the records.

Importance of medical procedure codes

medical procedure codes
The health sector relies heavily on medical procedure codes as well as other codes such as diagnosis codes, dental procedure codes etc. This is because these codes provide an easy and common method by which patient records can be understood.
Therefore, health care facilities and providers everywhere can understand what a particular code means on the record of any patient. It is just a matter of looking up the code to understand what condition the patient was suffering from and the treatment that was given.
Medical procedure codes help insurance companies to know exactly what they are paying hospitals for. This is because each code has its own allotted payment and a diagnosis code must match the proper procedure code in order for payment to be made to health care providers. This ensures that hospitals only charge for services that they have actually provided.
Any unnecessary medical cost or procedure is therefore eliminated. This way, hospitals have to be careful with regards to what they charge patients and their insurance companies for.

Patients benefit from medical procedure codes

Patients stand to benefits a lot from medical procedure codes. This is because they can look these codes up and know exactly what their medical condition was, the type of treatment and services they were provided with, how much the standard cost of each treatment or service is.
This way, they can access lot of information and be knowledgeable about medical procedures, costs etc. These codes are therefore very useful to patients, hospital facilities and insurance companies as a whole.

What are Medical Procedure Codes?

In the health care sector medical coding is used vastly to assign codes to patients’ diagnosis and the subsequent medical procedures. These codes are therefore very important since they are used to prepare patients’ bills. These bills are then sent to medical insurance companies for payment to the hospitals or health care providers.

Types of medical procedure codes

Medical procedure codes are numerous and each is used to signify something different. These codes cover so many types of treatments and services that are available presently. This means that every treatment and service that is provided to a patient has its own code. This has the advantage of helping patients and insurance companies track down exactly what type of procedures and services were carried out and how much they cost.
Al types of diseases including chronic ones, all types and manner of accidents and a large array of medical conditions have their own codes that are used to identify them. Medical procedure codes therefore make it easier to accurately note down various treatments that a patient has undergone and receive payment for all.
Every year, the code database is updated to include new medical conditions and treatment methods. This helps to keep medical procedure codes up to date and current thus eliminating confusion and payment problems.

How medical procedure codes are used

medical procedure codes
When a patient is brought in and diagnosed, then the required procedure’s code is looked up and added to their bill when the patient has been treated. This bill is then presented to the patient or the insurance company in charge of payment.
Doctors and health facilities are then paid according to the specific amount that each procedure is allocated. This shows that without medical procedure codes, there will be no system of identifying and calculating the cost of treatments.
Because the medical procedure codes used are the same everywhere in every health facility, it is easier for doctors to understand the medical conditions and treatments that are written on the hospital records of any patient. The codes serve as a common language in the health sector.

Who is in charge of medical procedure codes?

Currently, there are more than thousands of codes that cover various kinds of diseases, injuries and medical conditions. Because of the sheer amount of codes, it can get overwhelming when trying to figure out which code to use on the report of a patient.
For this purpose, medical billing and coding experts are trained and hired by hospitals and other health facilities. These people are in charge of making sure that the correct code is assigned to each condition.
Only then can correct payment be made to doctors and health care practitioners. Because of the importance of medical procedure codes, it is important that health facilities and health care providers try to use only the best software or hire only the best coding professionals to handle their work. This is because even the slightest mistake can be detrimental.