International Classification of Diseases - Essay Example

?Running Head: ICD-9, CPT, and HCPCS ICD-9, CPT, and HCPCS of the APA format A patient admitted or treated in an inpatient or outpatient setting avails various physician and non-physician related services, equipment, procedures, items and pharmaceuticals. In the United States, funding for medical expenses is through private or public insurance system and in rare circumstances direct cash payment. In order to have a uniform system of financial transactions, coding system is being practiced all over the country by both private and public insurance companies. There are basically 3 types of coding systems that are used. One is the Current Procedural Terminology designed by American Medical Association and applied by physicians. The other is the Healthcare Common Procedure Coding System that is based on the Current Procedural Terminology. The third is the International Classification of Diseases designed by the World Health Organization. In many circumstances, a combination of the 3 is used, especially in an inpatient setting. Application of codes is a complex procedure and involves training. In busy schedules, coding errors can occur. In this essay, various coding systems are discussed briefly. Thesis statement: The purpose of this statement is to discuss various types of coding systems that exist. ICD-9, CPT, and HCPCS Introduction It has been estimated that every year, in the United States, there are more than 5 billion claims for health care insurers. In order to ensure that these claims are processed in a consistent, uniform and orderly manner, it is very essential to have standardization of coding systems (CMS, 2012). There are basically 3 systems of coding to describe the disease or condition of the patient, the services provided by the healthcare providers and the equipment, consumables and non-consumables used. They are Current Procedural Terminology, Healthcare Common Procedure Coding System and International Classification of Diseases. Without these codes, transactions in the medical billing cannot happen. These codes also ensure uniformity in billing to the patient, physician and medical billing. The codes "The CPT or Current Procedural Terminology is a uniform coding system consisting of descriptive terms and identifying codes that are used primarily to identify medical services and procedures furnished by physicians and other health care professionals" (CMS, 2012). These health care professionals use this coding system to identify procedures and services which they bill the public or private health insurance programs. CPT is a type of code set that is developed and maintained by the American Medical Association. The maintenance is through a particular editorial panel (Centore, 2013). The code set describes various surgical, diagnostic and medical services, the copyright of which is protected by the American Medical Association. The code set is basically designed to communicate information in an uniform manner about various medical procedures and services among patients, physicians, coders, organizations responsible for accreditation and payers for various purposes with respect to analytical, administrative and financial aspects. Each year, new editions are released, mostly in the month of October. The current version is CPT 2013. Decisions pertaining to deletion, revision or addition of CPT codes are mainly done by the American Medical Association. The CPT codes are updated and also republished annually by the association (Centore, 2013). According to the CMS (2012), "level I of the HCPCS, the CPT codes, does not include codes needed to separately report medical items or services that are regularly billed by suppliers other than physicians." Coding using CPT is similar to that of ICD, except the fact that the coding identifies services that are rendered rather than the claimed diagnosis. This system of coding is identified by the Medicaid and Medicare Services. CPT codes fall into 3 categories, category-1, category-2 and category-3. In category-1, there are six sections, names, codes for evaluation and management, codes for anesthesia, codes for surgery, codes for radiology, codes for pathology and laboratory and codes for medicine. In category 2, codes for performance measurement are there and category 3 has codes for emerging technology. Users of CPT code are required to pay license fees to the AMA (Centore, 2013). CPT codes are mainly used by physicians to describe the various services they provide. It is mandatory for a physician to describe their services through CPT codes. Medical billers who need to use these codes have to purchase the coding books or avail online access by paying AMA. The AMA site for CPT codes allows to search for the code or the name of service or procedure. But there is a limit for 25 searches t a time. The codes may also be present in the form of a sheet or superbill and this may be shared with the patient at the physician's reception (Centore, 2013). International Classification of Diseases or ICD is a code that is mainly designed for the promotion of international comparability in the processing, collection, classification and also presentation of statistics related to mortality. The code includes a format to report various causes of death on the death certificate. Conditions that are reported on the certificate are then translated into medical codes by means of structured classification and also by application of modification rules. ICD is published by the World Health Organization (CDC, 2009). The coding rules are useful because they give preference to some categories, they cause consolidation of the conditions and they also help in identifying a single cause of death from the sequence of medical events that have occurred. The coding also helps in identifying non-underlying cause of death. The current revised version is the ICD-9. It has been revised and modified for the purpose of use in the United States. It is not available in print. The International Classification of Diseases, Clinical Modification (ICD-9-CM) is a related classification that is used to assign codes to various diagnoses related to inpatient, outpatient and utilization of physician office in the United States (CDC, 2009). Healthcare Common Procedure Coding System or HCPCS is a set of procedure codes related to health care. The coding is based on CPT coding system. The system was established in 1978 for the purpose of provision of standardized system of coding that is necessary for medicaid, medicare and other insurance programs so that claims related to insurance are processed in an uniform and orderly manner (CMS, 2012). It is currently mandatory for use of these codes for claims related to insurance. There are 3 levels of codes. Level 1 codes are numeric and consist of codes related to CPT. Level 2 codes are alphanumeric and basically include services related to prosthetic devices and ambulance which are non-physician. They include supplies and items which are not covered by CPT codes. In level 3, the codes are known as local codes. They are developed by the Medicare contractors, state Medicaid agencies and private insurers (CMS, 2012). They are for use in specific jurisdictions and programs. This level of codes is of course not present now to maintain consistency in the standards of coding. HCPCS level 2 code is the one used for this purpose. Level 2 code was set up to identify various equipments, supplies and services that are not identified by CPT codes and are outside the purview of physician's office (CMS, 2012). Conclusion There are basically three different coding systems used by medical billing companies, health plans and healthcare providers. There were developed to ensure consistency and reliability in the processing of claims related to healthcare companies from various health care providers and thereafter pay for their services. References CDC. (2009). International Classification of Diseases, Ninth Revision (ICD-9). Retrieved on 6th April, 2013 from http://www.cdc.gov/nchs/icd/icd9.htm. Centore, A. (2013). 2013 CPT Code Revisions: What the Changes Mean for Counselors. Retrieved on 6th April, 2013 from http://thriveworks.com/blog/2013-cpt-code-revisions-what-the-changes-mean-for-counselors/ CMS. (2012). HCPCS - General Information. Retrieved on 6th April, 2013 from http://www.cms.gov/Medicare/Coding/MedHCPCSGenInfo/index.html?redirect=/MedHCPCSGenInfo/ Read More