The Conundrums with Codes

Hospitals and medical facilities use two kinds of codes for filing healthcare reimbursement: ICD-9 and CPT. As they describe two separate details about a case, they always exist in pairs.

The International Classification of Diseases, Ninth Revision (ICD-9) was created by the World Health Organization in 1975 as a systematic classification of diseases and disorders. All member-states, including the U.S., adopt the ICD-9 to help with accurate recording of clinical cases and the like. The Tenth Revision (ICD-10) is scheduled to succeed ICD-9 by 2017.

The Current Procedural Terminology (CPT), on the other hand, is exclusive to U.S. hospitals and medical facilities since it’s maintained by the American Medical Association. If the ICD-9 codifies diseases, CPT codifies the treatment or approach performed. Compared to the ICD-9’s 13,000 codes (and ICD-10’s 68,000 codes), CPT only has less than 8,000.

Knowing the difference between these two codes accounts for proper filing of medical claims and reimbursement. No other code for identifying diseases than the ICD exists. On the other hand, other fields of medicine may have their respective codes for treatment, such as the Code on Dental Procedures and Nomenclature (CDT) for dentists.

Overall, identify the disease with the ICD-9 and identify the treatment with the CPT or CDT, depending on your field. Benefits of proper coding will come in the form of maximized revenue.

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