All acronyms are confusing, but CPT, ICD 10, and HCPCS codes are especially so. When it comes to medical billing and coding, these three abbreviations are used frequently. So, what exactly do these codes mean? In general, CPT codes are used in physicians’ offices, and HCPCS codes are used in hospitals. They are used for medical billing and coding for everything from getting a simple blood test to having a tonsillectomy. Before you can become a medical billing and coding specialist, you will need to know the basics.

In our modern healthcare world, medical insurance is the primary payer for health care. Insurance companies use diagnosis codes to determine their reimbursement schedules. To receive payment from insurance companies, your office must know how to bill the right codes using the correct terminology. To make sure the insurance company has confidence in your practice, all your medical billing needs to be done accurately and consistently.

What is ICD-10, CPT & HCPCS Coding?

To know if they are obligated to pay, an insurance company needs to know whether or not the medical services they provided were medically necessary and, if they were, what the medical code is for these services.

CPT and ICD-10 codes are two of the most common codes used in medical billing. However, they aren’t interchangeable. Doctors use CPT codes to submit claims to insurance companies, while insurance companies use ICD-10 codes to process those claims.

The claims submission process is standardized and follows the rules established by the Centers for Medicare and Medicaid Services (CMS), the country’s largest insurer.

CMS uses the Current Procedural Terminology (CPT) codes and the Healthcare Common Procedure Coding System (HCPCS) codes to identify procedures performed, procedures ordered, and products utilized. Remember that HCPCS codes are for non-physician services; these codes are also used to report physician services if they do not fall within one of the CPT codes.

ICD-10 Codes

ICD-10 was created in 17th century England and is the oldest coding system today, introduced by Sir William Farr, an English physician, and statistician. The original ICD code included 74 categories for diseases, anatomy, and accidents. Due to its comprehensive nature, by the mid-20th century, the ICD had become the most widely used system for occupational injury and disease classification in the U.S.

The modern ICD-10 is still based on Farr’s original model but has expanded to include more than 68,000 diagnosis codes. Because it is so vast, many countries have adopted a portion of it called the “clinical modification,” or “clinical versions”, to help improve clarity and specificity.

CPT Codes

A CPT code, which stands for Common Procedural Terminology, is a five-digit numeric sequence assigned to all medical, surgical, and diagnostic procedures. The American Medical Association develops and updates CPT codes annually to use in reimbursements and gathers information about treatment outcomes to evaluate the quality of care.

HCPCS Codes

CMS developed the Healthcare Common Procedure Coding System, a two-level alphanumeric system.

Level I represent the CPT index. In comparison, Level II is a separate system for coding medical products, such as prostheses and pharmaceuticals, and services, such as radiology and anesthesia. Currently, there are 17 categories, and more are being added; updates may occur as often as every six months.

Why is Medical Billing and Coding Important?

Besides providing medical billing services, medical coding has evolved into an important information tool and offers many benefits.

Medical coding is a universal language that everyone can understand, from billing to clinical specialists. At a glance, records can be cross-referenced. It takes seconds, not hours, to review a patient’s diagnosis at the emergency department, improving the efficiency of care. Even though medical coding is not hands-on care, this profession saves lives.

A paraprofessional can manage billing without the assistance of a clinician through coding. In the meantime, the doctors and nurses will be able to focus on what they do best, caring for patients, while trained administrative staff will handle billing. Payments are processed faster, and clinical resources are used sparingly, making them cost-effective for both hospitals and patients.

Healthcare professionals need a secure mechanism to share patient data across electronic health records (EHRs) and payers. In a world where healthcare privacy is becoming more sensitive, the ability to transfer this data securely is essential. Patients and providers have the right to establish privacy protections for their health information. The Health Insurance Portability and Accountability Act (HIPAA) is a United States Federal law that sets standards for protecting the privacy of medical records and other personal health information.

Despite this, extensive data are shared between insurers, doctors, nurses, office staff, and outside professionals.

In the past, insurers compensated healthcare providers solely based on the costs of their services, but that has changed now. Doctors and hospitals that perform well in today’s reimbursement system are paid more. For patients, this is a win.

Data is essential for benchmarking since it compares provider performance with industry leaders and best practices. Creating a metric tracking structure without the existing coding systems would be too costly.

Benchmark reporting is a valuable tool for consumers today, providing key statistics on hospitals, nursing homes, and physician performance. For example, patients with heart failure may benefit from providers with lower re-hospitalization rates. It gives you the confidence to know which facilities have a successful track record.

Public health authorities use coded data to analyze general health issues and monitor the disease’s prevalence among demographic groups. Agencies like WHO and CDC collect morbidity and mortality statistics. A medical journal always cites ICD-10, CPT, and HCPCS codes when reporting changing trends in death rates from heart disease or diabetes.

Public health planners rely on statistics to support their work at all levels of healthcare. Medical coding enables these tasks during a pandemic:

·        The prevalence of diseases by age

·        Analyze the causes of death

·        Utilization of hospitals and ICUs

·        Monitor the use of medical equipment, such as ventilators

·        Evaluate the outcome of the treatment

·        Providing reimbursement for audits

In near-real-time, officials can monitor and respond to outbreaks.

What will be the future of medical coding?

Investing in education pays off. Will medical coding still be relevant in another ten years? It is essential for students as jobs are being replaced by technology. 

Health experts agree that coding is an essential tool for reimbursement and research since it efficiently conveys expansive volumes of health data. It is impossible to find meaningful data without it. As a result of coding, records become more organized and easier to manage. Coding is a career that offers a future just because of its lower costs.

Medical technology is becoming more dependent on cloud-based applications for medical records, which will require more education and a more complex coding process. With a shortage of medical billing and coding specialists, more and more employers are looking for help from vocational schools that have well-trained graduates.

I will conclude by saying this

In the healthcare industry, billing and coding specialists are key players. Public health is boosted, reimbursement is streamlined, and government policies are strengthened. After a few months of studying in a full-time program at a vocational school, students can be prepared for a rewarding career with plenty of room for professional advancement.

About Scribe Align LLC

With the rise of medical billing services, there is also a rise in the use of medical scribes. What are scribes? Medical scribes are trained medical professionals who help providers with their documentation. Scribes are medical professionals who help medical professionals achieve more in less time.

Scribe Align LLC is a medical billing company located in Las Vegas, Nevada. As medical coding professionals, we manage your complete medical billing cycle, from claim preparation through reimbursement.

Here are just a few of the benefits of using our services:

·        Improve your cash flow.

·        Eliminate the need to hire an in-house billing team.

·        This will give you more time to treat your patients.

·        Improving patient compliance and collections

The challenges encountered by many providers are the complexity of the insurance industry and the numerous accounting requirements for those who employ in-house coders. By outsourcing your billing to Scribe Align LLC, you can be confident that your billing is being done correctly, efficiently, and professionally.