How To Choose a Medical Coding Manual for Billing?

One of the most important aspects of a medical facility is accurate medical coding for prompt reimbursement. Claims are placed electronically using the CMS-1500 health insurance claim form; however, choosing correct codes to describe services rendered is the initial and important part of this process. Coding translates descriptions of diseases, procedures, injuries, supplies, and other medical services into alphanumeric or numeric formats. Three coding systems are used here in the United States today and throughout most of the world to make these necessary decisions. It is essential to understand the human body and its functions in order to make the correct coding choices. This article describes briefly the three CPT, HCPCS and ICD-9-CM medical coding systems

Current Procedural Terminology (CPT)

Developed by The American Medical Association, CPT coding converts medical procedures into a five-digit, numeric code with two-digit modifiers. Divided into seven sections, the CPT manual is issued every year in October. These sections include evaluation and management, anesthesia, surgery; radiology, nuclear medicine and ultrasound; laboratory and pathology, medicine, and the index. Occasionally, CPT codes need modifiers that may indicate an unusual type of service. Two-digit alphanumeric modifiers are added to the original CPT code. The CPT system is used to code medical procedures.

Healthcare Common Procedure Coding System (HCPCS)

Created by Medicare in 1983, HCPCS codes supplement the basic CPT coding system. These codes are required for Medicare and Medicaid patients. HCPCS codes are of three levels. For example, level II includes required codes for medical equipment and ambulance services. Many of these codes are five-digit alphanumeric and use the letters S and W through Z.

Coding Medical DiagnosisPublished annually, the ICD-9-CM, which is now the ICD-10-CM, is available by the NCHS and Centers for Medicare and Medicaid. The manual is divided into three volumes. Volume I lists the diagnostic codes in numerical order, volume II lists all known diagnoses alphabetically, and volume III is a list of procedures in tabular form. Additional codes are E codes, V codes and M codes.

As evidenced in this short description, the medical billing and coding topic takes an in-depth study far beyond the scope of this article. Billing for a medical service or diagnosis is the end of this process; however, choosing the codes accurately is important for reimbursement. Before submitting the claim, it is a good idea to do an in-depth study of the service rendered and make an informed decision as to which code book is most appropriate.