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Medical Coding

Medical coding is a more like translation. Medical Coders take reports from doctors, which includes patient’s condition, doctor’s diagnosis, prescriptions, procedures the doctor or healthcare provider performed on the patient, and turn that into a set of codes, which make up a essential part of the medical claim.

According to the Centers for Disease Control (CDC), there were over 1.2 billion patient visits in the past year. At a minimum even if there are 5 codes derived from each visit, this accounts to near about 6 billion individual pieces of data, which is an almost unrealistically low estimate, that needs to be transferred and interpreted for statistics and reimbursement each year.

Coding allows for uniform documentation between medical facilities. Having uniform data allows for efficient research and analysis, which government and health agencies use to review and analyze health trends much more efficiently.

Types Of Codes You Need To Know:

  • ICD (Classification of Diseases, or ICD codes )

  • CPT ( Current Procedure Terminology, or
    CPT codes )

  • HCPCS ( Healthcare Common Procedure Coding System )

ICD : International Classification of Diseases, or ICD codes

These are diagnostic codes that create a uniform vocabulary for describing the causes of injury, illness and death.

The code that is currently in use in the United States is ICD-10-CM. This means it is the tenth revision of the ICD code set, and “-CM” at the end stands for “clinical modification.” The Clinical Modification significantly increases the number of codes for diagnoses.

This increased scope gives coders much more flexibility and specificity, which is essential for the profession. To better understand how important the clinical modification is, the ICD-10 code set has 14,000 codes. Its US model clinical modification, ICD-10-CM, contains over 68,000.

ICD codes are used to represent a doctor’s diagnosis and the patient’s condition. In the billing process, these codes are used to determine medical necessity. Coders must make sure the procedure they are billing for makes sense with the diagnosis given.

CPT: Current Procedure Terminology, or CPT codes

These codes are used to document the majority of the medical procedures performed in a physician’s office. This code set is published and maintained by the American Medical Association (AMA). These codes are copyrighted by the AMA and are updated annually.

CPT codes are five-digit numeric codes that are divided into three categories. The first category is used most often, and it is divided into six ranges. These ranges correspond to six major medical fields: Evaluation and Management, Anesthesia, Surgery, Radiology, Pathology and Laboratory, and Medicine.

The second category of CPT codes corresponds to performance measurement and, in some cases, laboratory or radiology test results. These five-digit, alphanumeric codes are typically added to the end of a Category I CPT code with a hyphen. Category II codes are optional, and may not be used in the place of Category I codes.

The third category of CPT codes corresponds to emerging medical technology. As a coder, you’ll spend the vast majority of your time with the first two categories, though the first will undoubtedly be more common.

HCPCS: Healthcare Common Procedure Coding System

Healthcare Common Procedure Coding System (HCPCS), commonly pronounced as “hick picks,” are a set of codes based on CPT codes. Developed by the CMS (the same organization that developed CPT), and maintained by the AMA, HCPCS codes primarily correspond to services, procedures, and equipment not covered by CPT codes. This includes durable medical equipment, prosthetics, ambulance rides, and certain drugs and medicines.

Medical Coding Vocabulary & Key Terms

There are a number of important terms you will want to familiarize yourself with as you learn more about coding. Let us look at some of these now.

  • Category (CPT)

  • Category (ICD)

  • Clinical Modification

  • CMS

  • CPT

  • Hcpcs

  • E-Codes

  • Evaluation And Management (CPT)

  • ICD

  • Modifier

  • Modifier Exempt (CPT)

  • NCHS

  • Pathology

  • Subcategory

  • Subclassification

  • Technical Component

  • V-Codes

  • Who

  • Z-Codes

  • Modifiers

  • Conventions)

    Brackets []

    Parenthesis ()




    See Also

    Code First

    Use Additional Code

    In Diseases Elsewhere Classified

    Not Elsewhere Classified

    Not Otherwise Specified