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WHAT IS MEDICAL CODING?
Medical coding is a complex but necessary task in medical billing offices used to report,track, and bill for services rendered by medical practitioners (e.g. physicians, nursepractitioners), ancillary providers (e.g. chiropractors, psychologists), or facilities (e.g.hospitals, nursing homes). Varieties of codes are used to consistently report medicalservices, procedures, supplies and equipment, and diagnoses. Codes are used toconvey complex medical language quickly and effectively to insurance companies, aswell as to other organizations such as Medicare, the American Medical Association, andthe World Health Organization. Many organizations utilize statistics mined from billinginformation for tracking purposes, such as frequency of office visits, severity of diseases, or even disease progression.
WHAT ARE MEDICAL CODES?
There are six basic types of medical codes used in various aspects of medical billing:
Current Procedural Terminology, Fourth Revision (CPT-4
) – identifiesservices and procedures
International Classification of Diseases, Ninth Revision (ICD-9)
Healthcare Common Procedure Coding System (HCPCS)
– identifiesadditional services and procedures not listed in CPT; drugs dispensed in thephysician’s office or other facility (including injectables, topicals, and orallyadministered); supplies and equipment dispensed to the patient
National Drug Codes (NDC)
– identifies pharmaceuticals dispensed to a patientvia a pharmacy
– identifies bundled facility and technical services (e.g. nursingcare, radiology or laboratory rendered in a facility setting, and room and board)
American Dental Association (ADA) Dental Billing Codes
– identifies servicesrendered by dental practitioners (usually bundled into the HCPCS ‘D’ section)The focus of this course is CPT codes.
HISTORY OF CPT CODES
The American Medical Association (AMA) developed the CPT manual in 1966. The firstedition contained a mere 3,534 codes. To this day, the AMA maintains the CPTmanual, and it has been revised and updated on a yearly basis since 1977. The HealthInsurance Portability & Accountability Act (HIPAA) and Centers for Medicare & MedicaidServices (CMS) require the use of standard code sets to be used when reporting anyservice rendered to a patient. CPT is one of those standard code sets.The 2008 CPT manual contains six sections with over 8,600 numeric, five-digit codes.To conserve space, some CPT codes are indented or cross-referenced. A coder usingthe CPT manual to report services should always look up the codes in the index first,and not rely on the structure of the manual to be ‘led’ to a code.