The use of medical codes in healthcare facilitates the understanding of patient treatments and diagnoses by a variety of people in the medical and insurance industries. People who use medical codes are likely to have a working knowledge of the many phrases used to define the codes. As a coder in medical coding companies, it’s helpful to be familiar with this terminology so that you can enter codes more accurately, and thus make full use of all the hcc risk adjustment technology tools available.
This blog offers you a basic understanding of medical coding language, as well as a few real-world instances.
What does medical coding mean?
In medical coding, alphanumeric codes are used to indicate several areas of healthcare, such as diagnosis, treatments, and medical equipment. In addition to making it easier for everyone to read and understand critical information regarding a patient’s condition and treatment, these codes help to build a standardized system on which medical professionals and others may rely to learn about the services a patient has received and why.
A patient’s condition and treatment are classified using medical codes by medical or clinical coders for healthcare and financial specialists to examine.
What does medical coding terminology mean?
Language or phrases used to describe and explain medical codes are known as “medical coding terminology.” Rather than only their abbreviated numbers, medical coding terminology may incorporate the names of ailments and illnesses, therapies and medications, and even specific procedures and procedures themselves.
As you learn more about coding, you’ll need to get familiar with a number of key terminologies. Some of them are:
CATEGORY (CPT)
Three categories make up the CPT code set. In the largest and most often utilized category I, medical procedures and technology are included. Category II is used to monitor performance and collect additional information. Codes for new and innovative medical procedures and services are in Category III.
CATEGORY (ICD)
It is the first three characters of the ICD code that describe the underlying cause of the injury or illness in the ICD-10-CM system. Coders typically require subcategories and subclassification in order to describe a patient’s injury or disease precisely. However, in some circumstances, the category suffices. Categories in ICD-10-CM have three numbers.
CLINICAL MODIFICATION
The ICD code sets in the United States will include this classification, which was developed by the National Center for Health Statistics. Several countries have expanded and clarified the ICD code sets for their own national purpose; the United States, for example, has expanded ICD-10 from 14,000 codes to over 68,000 codes. The suffix “-CM” is appended to the end of the ICD code title to indicate the presence of this modifier.
CMS
Medicare and Medicaid Services. HCPCS code set revisions and maintenance by this federal agency are critical to healthcare today.
CPT
Procedural Terminology in Use Today. The American Medical Association (AMA) publishes, copyrights, and maintains the CPT code set, which is a comprehensive list of procedures and services performed on patients. The first category is the most significant and often utilized, and it is separated into three subcategories. Reimbursement is not possible without the use of CPT codes. Numeric or alphanumeric codes of five characters each are acceptable.
HCPCS
Common Procedure Coding System for Health Care, or just hick-picks in colloquial usage. This is the primary procedural code set used to report procedures to Medicare, Medicaid, and a significant number of other third-party payers. HCPCS is organized into two levels and is managed by CMS. Level I is the same as CPT and is utilized in the same manner as the first level. CPT does not cover any of the items or services listed in Level II.
E-CODES
ICD-10-CM codes covering external causes of injury, such as car accidents, poisoning, and homicide, are included in E-codes.
EVALUATION AND MANAGEMENT (CPT)
A part of CPT codes known as E&M is used to represent the evaluation and management of patients’ health. E&M includes the codes for visits to the doctor’s office and emergency room appointments, for example. Despite being out of order numerically, E&M can be found at the beginning of the CPT manual. Codes 99201 – 99499 are used for E&M services.
ICD
More than a century ago, the International Classification of Diseases was established as a set of medical diagnostic codes. Diseases and injuries can be described using ICD codes, which are still in use by the WHO. ICD-10-CM (see “Clinical Modification”) is the current standard. Numeric or alphanumeric ICD codes are used. To define the damage or sickness, they often follow with a decimal point and two to four characters, depending on the code set. These characters give extra information about the manifestation and/or location of the disease.
MODIFIER
When a process code is supplemented with a modifier code, which is a two-character code indicating an important modification, it does not alter the procedure’s definition. Alphanumeric modifiers are used with CPT codes, while numeric modifiers are used with HCPCS codes. An additional hyphen-delimited field is added to each procedure code to provide more information about that process, such as its Medicare eligibility status, as well as a wide range of other critical details. Using the CPT modifier -51, for example, payers are informed that this procedure was part of a series of procedures. To indicate a bilateral procedure that was solely conducted on the left side, the HCPCS modifier –LT is used.
MODIFIER EXEMPT (CPT)
Modifiers cannot be added to certain CPT codes. The CPT manual’s appendices provide a brief list like this.
NCHS
The Centers for Disease Control and Prevention. Clinical ICD code revisions and annual updates are created and published by the NCHS, a federal government body tasked with keeping track of health-related data.
PATHOLOGY
The study of disease and how it spreads and what may be done to prevent it.
SUBCATEGORY
ICD code subcategories describe the digits following the decimal point. This digit provides further information about the nature of the sickness or injury, as well as the location or manifestation of that illness or injury.
SUBCLASSIFICATION
A subcategory in ICD codes comes before the subclassification. As the subcategory is further subdivided into subclasses, more details about the manifestation, severity, and/or location are revealed. ICD-10-CM has a subclassification that identifies which visit this is for the doctor—whether this is a first medication for the ailment, a follow-up, or the diagnosis of a condition that is the outcome of a past accident or disease. Subclassification characters in ICD-10-CM may have up to three characters.
TECHNICAL COMPONENT
Procedures that only deal with the technical aspects of a medical process, without regard to the interpretive or professional aspects The administration of a chest X-ray may be included in a technical component, but the evaluation of that X-ray for disease or abnormality is not.
WHO
International Organization for Health Organization. These codes are created by this United Nations-affiliated agency, which is responsible for overseeing their creation and is one of the most renowned organizations in worldwide health.
Z-CODES
These codes indicate situations in which a patient seeks medical attention despite no apparent damage or illness. A patient may seek medical attention as a result of a history of illness in the patient’s immediate family.
Conclusion
It is common for medical coders, healthcare providers, billers, and insurance workers to use medical coding terminology to interpret medical codes and guarantee that a patient’s experience with health services is as seamless as possible.
