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There are two common medical coding classification systems that are in use.
They include the Current Procedural Terminology (CPT) and the International Classification of Diseases (ICD).
The ICD is an international system that classifies the mortality and morbidity statistics.
More than 100 countries use it.
This system is used in healthcare facilities to identify diseases and embark resources to provide care.
According to the WHO, 70% of health care expenditures in the world are designated using the ICD.
ICD-10 is the current version, featuring more than 68,000 codes for neoplasms, infections and parasitic diseases, congenital malformations, diseases of the digestive system, nervous system, and respiratory system.
ICD codes are alphanumeric and are given to each diagnosis, symptoms description, and cause of death.
The WHO develops, copyrights, and monitors the classifications.
In the US, the changes and modifications of the ICD codes are overseen by the NCHS (National Center for Health Statistics), a part of CMS (Centers for Medicare & Medicaid Services), together with WHO.
The ICD-10-CM a.k.a. International Classification of Diseases, 10th Revision, Clinical Modification system connects the issues arising in patients.
It uses three- to seven-digit alphanumeric codes that describe symptoms, signs, conditions, diseases, and injuries.
These codes are used together with the CPT codes, for procedures, to record the services health care providers perform on patients.
This is documented on the medical records and is reported to a payer for compensation.
The main criteria for a diagnosis or service is a medical necessity.
It’s used together with a CPT code.
On October 1, 2014, the ICD-10 replaced the previous version as the standard coding system in the US.
CPT codes are published by the AMA (American Medical Association), and about 10,000 CPT codes are in use.
The fourth edition that was designed to provide a uniform data set to describe medical, surgical, and diagnostic services, is used in the US and other countries.
CPT codes are alphanumeric and contain five digits.
They typically consist of five numbers, and sometimes, may have four numbers and a letter.
That depends on the type of service.
These codes are used to identify services, such as surgical, medical, diagnostic, or radiological.
The codes are submitted with ICD-10 codes on claims to payers.
This is what they use to determine reimbursement to a facility or provider.
The CPT Editorial Panel was implemented by the AMA.
It meets three times a year to review and discuss issues relevant to upcoming technologies and problems arising during procedures, as well as how they relate to a certain code.
Final Thoughts
These two classifications systems are used daily by medical billers and coders as well as providers.
They are the building blocks for this industry.
Billers and coders should obtain new versions of classifications every year to stay updated on any code modifications.
Otherwise, they can get denied claims or compliance issues.
Read the full guide: How to Become a Medical Biller and Coder