by David Berky
July 16th, 2014
Medical billing procedures have been much more effective since the advent of the Current Procedural Terminology (CPT) medical coding system. Developed by the American Medical Association (AMA), the CPT system was designed to help facilitate and standardize medical billing practices. The coding system consists of alpha-numerical codes which are designated to describe the various services and treatments a doctor or medical facility performs on their patients. These codes are entered into a database system which is used for billing insurance companies, Medicare and Medicaid. Through the use of this billing system, medical professionals are better able to keep track of their financial records and receipt of their medical payments.
How the Coding System Works
The billing of medical services is handled by professionals in the medical coding and billing field. Medical coders and billers convert the diagnostic and procedural data on a patient's record into predetermined CPT 5-digit codes that coincide with the service or treatment provided. Treatments could include such services as hospital visits, doctor visits, lab specimens and tests, x-rays, etc. In the event medical coders require more detailed information than the existing code provides, modifiers are added to the code for a more specific explanation of the treatment.
It is essential that medical coders and billers choose the appropriate code to substantiate the services the patient receives. Mis-coded claims could result in insurance companies refusing to pay for services provided, until proper codification has been received. Insurance companies and government agencies such as Medicare and Medicaid all utilize codes for their billing practices. The use of the CPT coding system enhances the billing process, enabling doctors and medical facilities to receive their payment with greater speed and accuracy.
Introduction of the ICD-9 Billing Codes System
In 1977 the World Health Organization (WHO) introduced the ICD-9 billing codes system (International Classification of Diseases-Ninth Edition with U.S. Clinical Modification - CM) to help codify mortality and morbidity data for different diseases around the world. By giving diseases, injuries and medical conditions a specific code, doctors could better categorize the various services they administered to their patients, justifying the expenses billed on insurance claims. By 1979, the ICD-9 system, modified for use in the U.S. and known as ICD-9-CM, had replaced all others used by American hospitals. By 1998, all U.S. physicians were required to use the ICD-9-CM codes to submit their medical claims.
The ICD-9 coding system helped to standardize the recording of diagnoses and treatments patients received by medical professionals in the U.S. and abroad. It consisted of two volumes of diagnoses codes and one of procedural codes. Over the years, ICD-9 has yielded many benefits to the medical profession to include:
- Providing a more consistent method of recording medical diagnoses and treatments
- Improving hospital and physician billing procedures
- Facilitating payment of doctor and hospital bills by insurance providers and Medicare/Medicaid services
- Facilitating medical research and educational programs and more.
Introduction of the ICD-10 Billing Codes System
In 1993, the WHO developed the ICD-10 billing codes system, a substantial upgrade from the ICD-9 design. The ICD-10 system was readily accepted by most all countries around the world at that time, with the exception of the U.S., which continued to utilize the ICD-9 model.
Currently, the ICD-10 classification system (with code sets ICD-10-CM and ICD-10-PCS) is scheduled to go into effect in the U.S. on October 1st, 2014. The coding system is more comprehensive and advanced than its predecessor, requiring that doctors be much more specific in their documentation of treatments in order for medical coders and billers to issue the appropriate codes in the billing process.
When introduced into the American market, this system will undoubtedly make a tremendous impact on how documentation is handled by both medical professionals and the coding and billing profession. At present, the responsibility of finding the appropriate diagnostic and procedural codes for billing purposes falls on the medical coding and billing profession. The changes wrought by the ICD-10 coding system may require that coders and billers upgrade their methods and tools to continue to provide the high level of performance required for their profession.
How Professional Coding Services Can Facilitate the Billing Process
Professional coding services such as FindACode.com can be of tremendous service to medical billers and coders in providing the codes they require faster and more effectively. FindACode utilizes extensive resources to facilitate the coders and billers in finding the precise code to coincide with the services and treatments doctors provide. FindACode is a professional subscription coding service specifically designed for the medical billing profession. The company currently has a comprehensive listing of all ICD-9 code sets used in the country today. In addition, it can provide medical billers with a listing of all forthcoming ICD-10 codes to include ICD-10-CM diagnoses and ICD-10-PCS procedure codes in preparation for mandatory hospital use in 2014.
All inpatient facilities such as hospitals will be required to use both ICD-10-CM and ICD-10-PCS code sets. Outpatient or professional physician/practitioner offices will be required to use the ICD-10-CM code set on claims submitted to Medicare, but may continue using the CPT/HCPCS code set to identify procedure codes. Most payers or insurance companies are following Medicare's lead, but it is possible that some could require procedure codes be submitted using the ICD-10-PCS code set. Thus medical coding and billing professionals are advised to become familiar with both ICD-10 code sets.
Upgrading to the ICD-10 medical coding system will enhance medical coding practices in the U.S. and place the country on par with other countries around the world. In like manner, medical coders and billers can upgrade their services to the medical profession by taking advantage of the advanced technology provided by FindACode.com.