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ICD9 codes are numerical diagnostic codes used by insurance companies to determine whether to pay for medical procedures. They are used in conjunction with CPT codes to describe the patient’s medical condition and the treatment received. The coding system simplifies the billing process and allows for efficient comparison of codes. It is important to have up-to-date copies of both the ICD9 and CPT manuals.
An ICD9 code is a numerical diagnostic code used by insurance companies to determine whether or not to pay for a test, treatment, or medical procedure. ICD stands for International Classification of Diseases, and the 9th edition is the most recent publication, with ICD9 expected for publication in 10. The ICD2013 codes are used in conjunction with CPT, or Current Procedural Terminology, codes in the medical billing process. CPT codes are used to describe the test or procedure itself, while ICD9 codes describe the patient’s medical condition that warranted the treatment. Without the medical justification provided by the ICD9 diagnostic code, many insurance companies will not pay the related claim.
Every time you are treated by a doctor or hospital, a bill will be sent to your insurance company. The doctor’s office uses a system called coding to tell the insurance company why you’re being treated and what treatments the doctor is charging for. CPT codes are used to describe treatments you actually received, such as a physical exam or X-ray. The ICD9 code is a diagnostic code that indicates why you have received treatment; it may describe symptoms, or it may describe known medical conditions such as high blood pressure or diabetes. Insurance companies then decide whether the treatment you received was medically necessary or appropriate for the diagnoses listed.
You may wonder why medical providers and insurance companies use number coding for their billing process, instead of just listing the name of the procedure or diagnosis. The biggest benefit of using number coding is that it provides a uniform system that is accepted by nearly all doctors and insurance companies, which helps eliminate confusion. Medical terminology is often based on Latin and scientific terms, which are easily misspelled or used in the wrong context, and can be very cumbersome to write or type into the billing system. The number coding system simplifies the billing process for both the medical staff and the insurance company.
The coding system also allows computer software to efficiently compare CPT codes to ICD9 codes and look for a logical relationship. For example, a bill for a chest x-ray makes logical sense if the bill has an ICD9 code that lists “shortness of breath” as a symptom. This bill would likely be paid without unnecessary delay. However, a bill for a foot x-ray, if accompanied by an ICD9 code describing a toe injury, would be rejected by the computer software as an error. This bill would then be sent back to the medical staff for correction before it could be paid.
As medical technologies change so rapidly, it is important to have the most up-to-date copies of both the ICD9 manual and the CPT manual. Both sets of codes are reviewed annually, and the reviews are available in both print and electronic versions. CPT codes are published by the American Medical Association. ICD9 codes are maintained by the National Center for Health Statistics (NCHS) and the Centers for Medicare and Medicaid Services (CMS). You can order updated manuals directly from one of these organizations, but usually you can also get updates from your billing software vendor.
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