Code Medical Procedures
Medical procedures are coded with a numerical tag which hospitals and facilities use to bill for services. Of course it's not as easy as it sounds. In order to code a medical procedure, a patient's diagnosis must first be determined, which is also numerically coded. Once the medical diagnosis is established, the necessary procedures are assigned a code (called coding) and then the procedure can be billed.
Instructions
Understanding Codes
1. Diagnosis Codes
In order for a medical procedure to be performed, the patient must receive a diagnosis. Diagnosis codes are based on the World Health Organization's (WHO) list of clinical diagnoses called the International Classification of Diseases Clinical Modification 9th edition, better known as ICD-9-CM. ICD-9-CM codes are updated annually and are usually available in October or November preceding the new year. Medical billers must access the most recent codes in order to minimize errors and receive payment. ICD-9-CM publications are available in print or online. According to the Centers for Disease Control, the WHO will be releasing the ICD-10-CM (tenth edition) in 2013.
2. CPT / HCPCS Codes
Medical procedures are coded based on one of two sets of codes. CPT codes (Current Procedural Terminology) were developed and copyrighted by the American Medical Association (AMA) and are available for a fee. HCPCS Codes (Healthcare Common Procedure Coding System) are based on CPT codes and were created by the Centers for Medicare and Medicaid Services (CMS) in order for any individual to access medical procedure coding at no cost.
3. Accuracy in coding
Procedure codes must match diagnosis codes in order for payment to be received. For example, in order to charge for a sleep study (CPT 95810 or 95811) the patient must have a diagnosis that warrants such testing, such as Obstructive Sleep Apnea (ICD-9-CM 327.23).
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