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WORKING WITH THE ICD-10 AND CPT CODE SETS

ICD-10 code

One of the most challenging things about medical coding(ICD-10) today is the complexity of the different coding systems. To meet your goals for A/R days and keep your revenue cycle running smoothly, your coding staff needs to be able to quickly and efficiently prepare and submit claims for processing. Every day, medical staff at physicians’ offices work with both the ICD-10 and the CPT code set. Read on for the basics about each one of these code sets and what sets them apart from each other.

The ICD-10 Code Set

The International Statistical Classification of Diseases and Related Health Problems – 10th edition (ICD-10) is an international classification system of codes that encompasses a wide range of diseases, disorders, complications, and causes. By making it possible to categorize this data, ICD facilitates medical reimbursement and makes it easier to optimize resource usage and monitor health outcomes and quality of care.

About half of the codes within ICD-10 fall within the Clinical Modification (CM) category of this classification system. At the end of 2016, there were about 68,000 ICD-10-CM codes, and they can be used in all kinds of healthcare facilities. However, it is important to note that there are also about 76,000 ICD-10 codes that fall within the Procedure Coding System (PCS) category. ICD-10-PCS codes can only be used to code for hospital inpatient procedures.

The CPT Code Set

The Current Procedural Terminology (CPT) system was created by the American Medical Association (AMA) solely for medical billing purposes. Unlike ICD-10 codes, which can be used for the wide range of purposes described above, the Current Procedural Terminology (CPT) code set is used only to report claims to insurance payers so that a healthcare facility can get paid for services. When a claim is submitted to the insurance payer, the payer wants to know more than just the diagnostic outcome of the visit. The CPT code not only identifies the existence of a medical condition, but it also signals the type of treatment sought by the patient and the assessments and tests that the physician performed and/or ordered.

It is important to note that there are also Category II and Category III CPT codes that extend beyond the primary purpose of the CPT in medical billing. CPT II codes are used by healthcare facilities to identify additional services related to a health care visit that cannot be billed, but that can help monitor quality of care and resource utilization. Similarly, category II codes can be used to keep track of outcomes when doctors try out new and innovative medical techniques.

It can be hard to keep track of the codes in these two distinct code sets. In order to ease the burden of medical coding on your staff and to keep your revenue cycle running smoothly, it can help to seek outside assistance for medical coding and billing experts. Contact AnnexMed today for more information about our services!

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