ICD-9 and CPT Codes

Insurance providers reimburse differently for in-patient Healthcare and out-patient Homecare. While the Healthcare system pays out for each medical procedure, the Homecare system instead pays out for each patient. The current Healthcare reimbursement system depends upon two sets of codes that specify when and how much a practitioner will be reimbursed for each procedure. The International Classification of Diseases (ICD-9) code set is the inventory of conditions from which a doctor can justify doing a procedure. For example, a doctor would not be reimbursed for a Holter monitor prescribed to a patient who is exhibiting symptoms of the flu, since there is no relevant ICD-9 code. The Current Procedural Terminology (CPT) code indexes the reimbursement amount for each procedure, assume that ICD-9 guidelines are fulfilled. Unlike ICD-9 codes, the reimbursement amount for each CPT code will almost always vary between differing locations and insurance providers. In addition, CPT codes may be broken in broken down or modified into various sub-codes depending on the circumstances. For example, the event monitoring code 93268 can be broken into 3 separate CPT codes: 93270 used by the physician to bill for the actual ECG recordings, 93271 for the owner of the recorders to provide 24/7 monitoring, and 93272 for the physician to review and interpret the scans. The sum amount of these 3 codes will equal the amount of the main or global code, 93268. In breaking the code out, several parties can bill for different components of the overall medical care, which enables each party to streamline and automate their business models. For more information on ICD-9 and CPT codes click in the following links respectively: http://www.wisegeek.com/what-is-icd9.htm; http://healthfrontier.health.officelive.com/93268.aspx .

HCPCS Code

Healthcare Common Procedure Coding System (HCPCS) is a broader term for a CPT code. Like the CPT code, the overall purpose of the HCPCS is to simplify and standardize medical billing procedures. There are 2 sets of HCPCS codes: Level 1 code is the 5 digit numeric code also known as the CPT code which is maintained by the American Medical Association. Level 2 code includes durable medical equipment (DME), prosthetics, orthotics, and supplies. Level 2 code are alpha-numeric where they begin with a single letter, follow by 4 numbers. For more information click on the following link: http://www.nls.org/av/FAQ's%20HCPCS.pdf