Insurance

Medical insurance codes simplify the narrative description of diseases, injuries and healthcare procedures to accurately signify the diagnoses and the various procedures performed. These codes determine the reimbursement the physician receives from CMS and private payers. Accurate medical coding plays a crucial role in ensuring timely reimbursement of medical claims and creating a relevant record of patient care history. For the same reason, physicians and their office staff are required to stay updated with the various relevant insurance codes.
The medical coder will abstract the required information from the clinical documents, assign the appropriate codes, and create a claim to be paid by CMS. These codes will be present in your Explanation of Benefits (EOB) form and medical bills.
Available Medical Coding Systems
Current Procedural Terminology (CPT)
Developed by the American Medical Association in 1966, CPT codes describe the type of service you provide to a patient. With new changes in the practice of healthcare, new codes will be developed for new services, current codes will be revised, and old, unused codes discarded. CPT falls into three categories - Category I, Category II, and Category III.
Category I are five digit numeric codes. These codes represent procedures that are consistent with contemporary medical practice and are widely performed. Some examples are:

• 90791 - Psychiatric diagnostic evaluation
• 90845 - Psychoanalysis
• 00524 - Anesthesia for closed chest procedures; pneumocentesis

Category II codes describe clinical components that may be typically included in evaluation and management services or clinical services. Followed by the alpha character 'F', these codes may not be used as a substitute for Category I codes.

• 0500F- 0575F for Patient Management

Category III codes are temporary codes for emerging technology, services and procedures. The procedure or service must be involved in ongoing or planned research, to be eligible for these codes.

• 0319T - insertion or replacement of a subcutaneous implantable defibrillator system including pulse generator and lead

Healthcare Common Procedure Coding System (HCPCS)
HCPCS codes involve standardized codes that represent medical procedures, supplies, products and services. HCPCS is divided into two subsystems, Level I and Level II. Level 1 is the same as CPT codes. HCPCS Level II codes are not included in CPT, such as ambulance services and durable medical equipment, prosthetics, and supplies used outside the physician's office. This set of codes is updated on a quarterly basis and improvements are made based on public feedback.

• V5284, personal FM/DM, ear level receiver
• V5267, hearing aid or assistive listening device/supplies/accessories, not otherwise specified

International Classification of Diseases (ICD)
ICD classifications are developed, monitored and copyrighted by the World Health Organization (WHO) in 1893. In the U.S., the NCHS (National Center for Health Statistics), part of CMS (Centers for Medicare and Medicaid Services) oversees all changes and modifications to the ICD codes, in association with WHO. ICD is the standard diagnostic tool for epidemiology, health management and clinical purposes. These codes are used in combination with the CPT codes to make sure that the health condition and the services the patient received match.
The 9th version of ICD currently in use will be replaced by ICD-10-CM on October 1, 2014. ICD-9 cannot accommodate more additional disease classification or newly identified diseases. In order to get medical claims paid, physicians should be prepared with the necessary upgrades and/or changes to billing software, systems, and procedures that will be affected by the implementation process. ICD-10 codes will also impact the current medical billing process such as clinical documentation, revenue cycle management, data analysis and reporting.
Examples of ICD 10:

• G12.29 Labioglossal paralysis
• S52.5 Fracture of lower end of radius
• Q82.8 Dermatomegaly NEC

Apart from correctly assigning these insurance codes for accurate medical claims, there are several other intricate steps involved in a medical billing process. The process can be a time-consuming task for busy physicians and hospital staff. A reliable medical billing company will provide services of AAPC certified coders, regularly updated with the changes in coding and billing guidelines. Error-free codes can speed up your reimbursement process, reduce payment denials and delays.