Each profession has its own jargon. The language used specifically in a communicative context and may not be well understood outside that context. Language that is understood by the people within specific areas of expertise. Medical codes are the universal language of understanding between payers and providers and hence used for communication and billing purposes. The financial criticality for both payers and providers mean that providers have to be compliant and accurate in coding for medical treatment provided.
To enter into the medical field, specifically midwifery, one must have enough knowledge and understanding with medical codes. Codes and descriptions that play a vital role in the billing procedures of all medical services rendered. Having the proper medical coding ensures that insurers have all the diagnostic codes required for appropriate payment. In this article, we will have a closer understanding in dealing with CPT codes, diagnostic codes and service locations.
What is CPT Code?
The Current Procedural Terminology (CPT®) codes offer doctors and health care professionals a uniform language for coding medical services and procedures to streamline reporting, increase accuracy and efficiency. Administrative management purposes, such as claims processing and developing guidelines for medical care review, also use CPT codes.
The CPT terminology is the most widely accepted medical nomenclature used across the country to report medical, surgical, radiology, laboratory, anesthesiology, genomic sequencing, evaluation and management (E/M) services under public and private health insurance programs. All CPT codes are five-digits and can be either numeric or alphanumeric, depending on the category. CPT code descriptors are clinically focused and utilize common standards so that a diverse set of users can have a common understanding across the clinical health care paradigm.
What is Diagnostic Code?
In healthcare, diagnosis codes are used as a tool to group and identify diseases, disorders, symptoms, poisonings, adverse effects of drugs and chemicals, injuries and other reasons for patient encounters. Diagnostic coding is the translation of written descriptions of diseases, illnesses and injuries into codes from a particular classification. In medical classification, diagnosis codes are used as part of the clinical coding process alongside intervention codes. Both diagnosis and intervention codes are assigned by a health professional trained in medical classification such as a clinical coder.
As the knowledge of health and medical advances arise, the diagnostic codes are generally revised and updated to match the most up to date current body of knowledge in the field of health. The codes may be quite frequently revised as new knowledge is attained.
What are Service Locations?
A service location is where services are rendered to a patient. This can be a hospital, the provider's office, or a nursing home, for example. In medical billing, service location is presented through the place of service (POS) dodes. Place of service codes are two-digit codes placed on health care professional claims to indicate the setting in which a service was provided. The Centers for Medicare & Medicaid Services (CMS) maintain POS codes used throughout the health care industry.
Here’s the complete Place of Service (POS) Codes lists
CPT Codes, diagnostic codes and service locations are three different coding classifications used in diverse areas. Healthcare is highly regulated, therefore understanding these three factors are very important. Although it may seem overwhelming with the number of codes you might need to use, the terminologies you might encounter every once in a while, when you have a basic understanding of them, you’ll have the foundation you need to start billing insurance in your private practice. Now you’ll have the opportunity to open up care to more clients, grow your practice and your impact.
Hazelwood, A (2005). ICD-9-CM Diagnostic Coding and Reimbursement for Physician Services 2006 Edition (PDF). United States of America: American Health Information Management Association. p. 2. Archived from the original (PDF) on 2013-07-18. Retrieved 2013-05-27.
M, M. (2021, December 3). Revisiting the basics: Understanding medical coding. Medical Billing Wholesalers. Retrieved August 5, 2022, from https://www.medicalbillingwholesalers.com/the-revenue-cycle-blog/revisiting-the-basics-understanding-medical-coding#:~:text=Medical%20Codes%20are%20the%20universal,Coding%20for%20medical%20treatment%20provided.
Place of service codes. CMS. (n.d.). Retrieved August 5, 2022, from https://www.cms.gov/Medicare/Coding/place-of-service-codes