Patient’s Guide to Medical Codes and Billing

Medical coding and billing are the invisible engines of the modern healthcare industry. Medical coding is the translations of medical documentation into universal healthcare code sets. Medical billing company takes the description of a disease, injury, and procedures from physicians and transforms them into alphanumeric codes to accurately describe all the diagnosis and procedures performed.

Medical isn’t always exact. There are different ways of diagnosing, preventing and treating ailments. Medical coding helps define the specific path a doctor took in treating a patient.

Medical coding classifies thousands of conditions, injuries, diseases, causes of death, services provided by medical specialists, injectable drugs, and other medical supplies for easy tracking and reporting. The multiple descriptions, names, eponyms, and acronyms of tools, procedures, and diseases are all put in a standardized language so that they can be easily tracked and understood. Medical coding improves the healthcare services rendered by physicians by helping them track your past health records.

Medical coding and billing as a language to facilitate communication between hospitals, providers, and payers like insurance companies. Coding lets the insurance payer know the exact injury or disease of his client and the specific method of treatment.

Types of Codes Used

Medical coding is universal, the CPT codes, ICD codes, HCPCS codes, and DRG codes are global. They all help in communicating and billing. Here is what each of them entails:

  1. ICD Codes

The International Classification of Disease (ICD) codes helps in classifications of symptoms, diagnosis, and causes of deaths in human beings. The World Health Organization oversees these codes to ensure they are standard and recognizable by health practitioners worldwide.

  1. HCPCS Codes

The Healthcare Common Procedure Coding System (HCPCS) codes are used to identify products and services not included in ICD codes when used outside a physician’s office.

  1. CPT Codes

Current Procedural Terminology (CPT) codes are trademarked by the American Medical Association in 1966. It is a system of five alphanumeric characters describing the standard surgical, medical, and diagnostic services. CPT codes give a medical billing company all the proceedings of a surgery.

  1. DRG Codes

Diagnostic Related Grouping (DRG) codes are related to inpatient claims. Insurers pay as per DRG. It is essential for billing and proper reimbursement. A medical billing company uses DRG codes to ensure your claims are taken care off on time.

  1. CDT Codes

Current Dental Terminology (CDT) code is a Dental Procedure and Nomenclature code owned and maintained by the American Dental Association. They are five-character codes starting with the letter D. They are for billing dental and oral procedures.

  1. NDC Codes

The National Drug Codes (NDC) codes are owned and managed by the Federal Drug and Administration (FDA). They are 12 alphanumeric characters used to track and report all drug packages. They help suppliers, providers, and federal agencies determine the specific drug prescribed, sold, and used.

  1. APC Codes

Ambulance Payment Categories (APC) codes are under the Center for Medicare and Medicaid Services. APC help support the Hospital Outpatient Prospective Payment System (HOPPS) in billing hospital outpatient services such as minor surgeries reimbursed under the system.

  1. Modifiers

HCPCS Level II codes and CPT codes use hundreds of alphanumeric two-character modifiers to add clarity. They help indicate the patient’s status, the specific body part receiving the service, payment instructions, and quality element.