Medical coding is one of the rapidly growing fields in the pharma and healthcare industry. The practice of clinical documentation is varied and critical, and also requires multiple standardized code sets and terminologies to support all of its use cases. There are various coding systems used in medical coding and the medical billing process. Each system has a unique purpose and is related to the diagnosis and treatment of patients and reimbursements that correspond to their care. In this blog, we will discuss the different coding systems used in medical coding, such as ICD-10-CM, CPT, and HCPCS coding systems.
What is Medical Coding?
Medical coding is the process of translating healthcare diagnoses, procedures, services, and equipment into universal alphanumeric medical codes. These codes are derived from various sources within the medical record, such as the physician’s notes, laboratory results, radiology findings, etc. These codes are used by insurance companies and pharma companies. Here are some job roles in the medical coding career.
Career Roles in Medical Coding: Medical coder, medical billing specialist, coding auditor, compliance analyst.
What is ICD-10-CM?
- ICD stands for the International Classification of Diseases (ICD) system. It has a long healthcare history dating back to the 1800s.
- ICD-10 stands for the 10th Revision of the International Statistical Classification of Diseases and Related Health Problems. It is maintained by the World Health Organisation (WHO).
- The ICD-10-CM stands for International Classification of Diseases, 10th Revision, Clinical Modification. It is the U.S. adaptation of the ICD-10, developed by the National Centre for Health Statistics (NCHS), a division of the Centres for Disease Control and Prevention (CDC).
These are seven-character alphanumeric codes and these are been used in billing globally since 1977. They help to classify every disease, injury or symptom known to medicine. These alphanumeric codes are also helpful to track health data and mortality statistics by public health officials. ICD codes are regularly updated by the World Health Organisation, roughly every ten years on average.
What is CPT?
CPT refers to the Current Procedural Terminology system that is developed and maintained by the AMA (American Medical Association). It is a standardised system being used across the healthcare industry to identify and document medical diagnostic services and surgical procedures. Here are a few important factors of the CPT system
Purpose of the Current Procedural Terminology (CPT) System: It was originally created for the process of standardising the documentation of medical procedures and determining work value. Now, CPT codes help providers in documenting services accurately to obtain appropriate reimbursements.
Structure of the CPT system: These codes have five characters, which mostly involve numeric characters. But some may be alphanumeric depending on the category.
Usage of the CPT system: Healthcare providers use the Current Procedural Terminology (CPT) System codes to report patient services to government agencies and insurance companies. This helps them to form a key part of the national coding system under HIPAA for accurate billing and data reporting.
CPT system maintenance: The CPT Editorial Board (AMA) manages the CPT codes. The board meets three times a year to review new code applications.
Updates of Current Procedural Terminology System: Every November, new or revised CPT codes are released, and they become effective from January 1st of the following year.
What is HCPCS?
HCPCS stands for the Healthcare Common Procedure Coding System. It is a standardized, alphanumeric coding system with two levels. HCPCS is developed and maintained by the Centres for Medicare & Medicaid Services (CMS), and they ensure uniform billing and documentation across healthcare services and supplies.
Structure of HCPCS:
- Level I: This level of HCPCS is based on the CPT codes system and is used for surgical, medical, and diagnostic procedures.
- Level II: This level of HCPCS covers the medical products and services, such as pharmaceuticals, prosthetics, durable medical equipment, ambulance services, and radiology, that are not included in CPT.
Purpose of HCPCS: The Healthcare Common Procedure Coding System is designed to bring consistency in billing, documentation, and reimbursement for Medicare and other insurance providers. It makes accurate process claims for medical supplies, outpatient services, and specialised care.
HCPCS maintenance: CMS updates HCPCS codes quarterly in January, April, July, and October. New codes take effect on the first day of each month following their release.
Format of HCPCS: Each HCPCS code is five alphanumeric and 5 characters long. They start with a letter followed by four digits.
- Example: J9355 – Injection, trastuzumab (excludes biosimilar), 10 mg
- Example: C1823 – Generator, neurostimulator (implantable), non-rechargeable, with transvenous sensing and stimulation leads
Overview
Medical Coding is a booming field in the healthcare industry and offers a wide range of job opportunities in various settings such as private and government hospitals, insurance companies etc. A medical coding career offers stable job opportunities with great growth aspects globally. CareerInPharma offers a Certification Course in Medical coding that makes you an expert in ICD-10-CM, CPT, and HCPCS coding systems. These skills and knowledge helps you achieve your dream career.
FAQs about Medical Coding Systems
1. What are the main coding systems used in medical coding?
The three primary coding systems used in medical coding are:
- ICD-10-CM: International Classification of Diseases, 10th Revision, Clinical Modification
- CPT: Current Procedural Terminology
- HCPCS: Healthcare Common Procedure Coding System
2. Why are medical coding systems important?
Medical coding systems are important because thry ensure accuracy, uniformity, and transparency in healthcare documentation and billing. They also support proper reimbursement, improve patient data tracking, and enable effective healthcare planning and research.
3. Who maintains these coding systems?
- ICD-10-CM is maintained by the National Center for Health Statistics (NCHS), under the Centers for Disease Control and Prevention (CDC).
- CPT is updated and managed by the American Medical Association (AMA).
- HCPCS is developed and updated by the Centers for Medicare & Medicaid Services (CMS).
4. How often are these codes updated?
ICD-10-CM is updated annually, CPT is updated annually, with changes taking effect January 1st each year. And HCPCS is updated quarterly which takes place in January, April, July, and October.
5. What qualification is required to pursue a career in Medical Coding?
Anyone with a bachelor’s degree in the following streams can become a medical coder:
- Computer Science
- Nursing
- Biomedical
- BPharma / Dpharma / Mpharma
- BSc or MSc in (BIo / Chemistry / Zoology / Botany )
6. How long does it take to complete a medical coding certification course offered by CareerInPharma?
Unlike other courses in the healthcare industry, online medical coding certification courses offered by CareerInPharma take only 2 to 6 months to complete.
