Important Medical Codes: An Overview

Medical codes are necessary to document the massive amount of data that every patient visit to a doctor would entail. It is not enough to list the symptoms, diagnoses, and procedures and share them with the insurance company. For example, if a patient visits the doctor with a serious injury, the amount of data would be more and should be communicated to the insurance company clearly.

If one billion people are visiting the doctor every year, then an unrealistically minimum estimate of 6 billion pieces of data needs to be transferred to insurance. Medical Coding allows the efficient and errorless transfer of data with huge volumes.

Coding allows uniform documentation across all medical facilities. Having uniform codes helps for efficient research and analysis. The government and health agencies use the data to track health trends efficiently. Anyone who wanted to become a medical coder has to be familiar with the following three types of codes that you will use every day:

International Classification of Disease (ICD)

ICD codes are diagnostic codes that create a consistent vocabulary for describing the medical conditions, illness, injury, and death. The number that follows ICD is the number of times the codes are revised. In ICD-10-CM, 10 is the 10th revision and CM is “clinical modification”. The clinical modification increases the number of codes for diagnosis, which increases flexibility and specificity for the medical coders. The difference between ICD-10 and ICD-10-CM is the former has 14,000 codes and the latter has 68,000 codes. ICD codes are used to represent the patient’s condition and what the doctor diagnosed it to be, which ensures its medical necessity and procedure while the billing process.

Current Procedure Terminology (CPT)

CPT is used to document the procedure that is performed in the doctor’s office. These are five-digit numeric codes that are divided into three categories.

The first one is used mostly and is divided into 6 ranges. These ranges are correlated to six major medical streams: evaluation and management, anesthesia, surgery, radiology, pathology and laboratory, and medicine.

The second category is mostly related to performance measurement and in a few cases laboratory and radiology test results.

The third one corresponds to emerging medical technology, which is rarely used. CPT codes have an addendum that increases the specificity and accuracy of the code used. There are CPT modifiers that provide additional information to the procedure code.

Healthcare Common Procedure Coding System (HCPCS)

HCPCS are the codes that cover the services, procedures, and equipment not covered by CPT codes. Since these codes are involved in Medicare and Mediclaim, these are important codes that a medical coder would use. Like CPT codes, HCPCS codes should correlate with the diagnostic codes that can justify the medical procedure. The medical coders are responsible for the outpatient procedure if they match the listed diagnosis.

These are the primary codes that a medical coder would use to code the particulars every day. Valliappa Foundation in collaboration with Tech Mahindra Foundation SMART is offering medical coding training for selected candidates. Medical Coding is one of the top jobs for a stable and long-lasting career, it is an excellent opportunity for candidates with science and life science backgrounds to take this medical coding training and make a career as a Medical Coder.