What Are Medical Codes for Billing?

medical-codes-billing Credit: GIPhotoStock/Cultura/Getty Images

Medical billing codes identify procedures, diagnoses and certain devices or equipment involved in the delivery and billing of health care services. The three major coding sets involved in medical billing are Current Procedural Terminology, Healthcare Common Procedures Coding System and International Classification of Diseases, 9th Revision, Clinical Modification.

Current Procedural Terminology codes are five-digit numerical codes that represent specific services a patient may receive from a health care provider. These codes are created and maintained by the American Medical Association. CPT codes promote standardization of billing among the health care community and determine the amount of reimbursement a health care provider may receive from an insurance company.

Healthcare Common Procedures Coding System codes are alphanumeric codes that report supplies, devices and equipment delivered to patients. Additionally, some procedures not elsewhere classified in the CPT set are included. HCPCS codes are regulated by the Centers for Medicare and Medicare Services.

Finally, the International Classification of Diseases, 9th Revision, Clinical Modification is a set of three-digit codes followed by a decimal point that is reported to an insurance company. It specifies diagnoses and disorders that a patient was treated for. ICD-9-CM is regulated by the National Center for Healthcare Statistics. ICD-9 codes are reported in conjunction with CPT and HCPCS codes to ensure accurate health care billing.

Medical billing takes the codes assigned during the medical coding process and changes them into charges to be billed to insurance companies or the patient. Medical billing follows the charges to insurance companies to make sure the medical facility receives reimbursement for the services provided. This may require getting clarification from physicians about diagnoses or procedures to ensure the proper billing and to minimize rejection from insurance companies.

As of 2014, training is not required by law for medical billing and coding, but finishing a certification course is encouraged. In offices where medical billing and coding are performed by separate employees, the employees often work together to make sure the invoices are accurate. Medical offices can also outsource billing and coding. In small offices, an employee that handles billing and coding could also be required to assist patients.