Medical codes are used to describe diagnoses and treatments, determine costs and reimbursements, and relate one disease or drug to another. Although the CPT code system is the most widely used, many other code sets are also in use. The different code sets are necessary because of the broad range of services and operations within the medical industry.Patients can use medical codes to learn more about their diagnosis, the services their practitioner has provided, to figure out how much their providers were paid, or even to double-check their billing from either their providers or their insurance or payer.This article discusses medical coding systems, what they are used for, and how you can use them to benefit your own health care.
Medical codes are used to describe diagnoses and treatments, determine costs and reimbursements, and relate one disease or drug to another. Although the CPT code system is the most widely used, many other code sets are also in use. The different code sets are necessary because of the broad range of services and operations within the medical industry.
Patients can use medical codes to learn more about their diagnosis, the services their practitioner has provided, to figure out how much their providers were paid, or even to double-check their billing from either their providers or their insurance or payer.
This article discusses medical coding systems, what they are used for, and how you can use them to benefit your own health care.
CPT Medical Codes
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Patients may be interested in looking at CPT codes to help them understand the services their doctor provided, double-check their bills, or negotiate lower pricing for their healthcare services.
CPT Codes and How They Are Used
CPT codes are organized into categories:
What are 5 common CPT codes?Different practices may use different codes more often than others, but some of the most common include:99213/99214: Office visit/Outpatient Services90791/90792: Psychiatric evaluation81002/81003: Urinalyses85025: Complete blood count90471: Vaccine administration
What are 5 common CPT codes?
Different practices may use different codes more often than others, but some of the most common include:99213/99214: Office visit/Outpatient Services90791/90792: Psychiatric evaluation81002/81003: Urinalyses85025: Complete blood count90471: Vaccine administration
Different practices may use different codes more often than others, but some of the most common include:
HCPCS Medical Codes
There are two levels:
ICD Medical Codes
How to Look up ICD Codes
ICF Medical CodesThe International Classification of Functioning, Disability, and Health is also known as ICF. ICF is a framework for measuring health and disability related to a health condition.While ICD classifies disease, ICF looks at how functional a person is in their environment.
ICF Medical Codes
The International Classification of Functioning, Disability, and Health is also known as ICF. ICF is a framework for measuring health and disability related to a health condition.While ICD classifies disease, ICF looks at how functional a person is in their environment.
DRG Medical CodesThe diagnostic-related group (DRG) system categorizes different medical codes. For billing purposes, hospital services are categorized based on a diagnosis, type of treatment, and other criteria.This means that hospitals are paid a fixed rate for inpatient services corresponding to theDRG assigned to a given patient, regardless of what the real cost of the hospital stay was, or what the hospital bills the insurance company (or Medicare) for.The assumption is that patients who fit the same profile will need approximately the same care and services. There are about500 different DRGs. They are updated annually to add new diagnoses or circumstances.Diagnostic Related Group (DRG) Codes
DRG Medical Codes
The diagnostic-related group (DRG) system categorizes different medical codes. For billing purposes, hospital services are categorized based on a diagnosis, type of treatment, and other criteria.
This means that hospitals are paid a fixed rate for inpatient services corresponding to theDRG assigned to a given patient, regardless of what the real cost of the hospital stay was, or what the hospital bills the insurance company (or Medicare) for.
The assumption is that patients who fit the same profile will need approximately the same care and services. There are about500 different DRGs. They are updated annually to add new diagnoses or circumstances.
Diagnostic Related Group (DRG) Codes
NDC Medical Codes
The National Drug Code (NDC), is a unique, numeric identifier given to medications. The code is present on all nonprescription (OTC) and prescription medication packages and inserts in the US. The NDC is 10-digits divided into three segments:
CDT Medical CodesCode on Dental Procedures and Nomenclature (CDT) codes allow dentists to get into the coding act. It is a set of procedural codes for oral health and related services.
CDT Medical Codes
Code on Dental Procedures and Nomenclature (CDT) codes allow dentists to get into the coding act. It is a set of procedural codes for oral health and related services.
DSM-IV-TR Medical Codes
While you may see these codes in existing patient records, the fifth edition of the DSM was published in 2013 and recommends ICD-10 codes for psychiatric conditions.These also change over time, as there was a revision in October 2017.
Summary
As a patient, you can use these codes to help understand more about your care and to make sure you are being correctly billed for services.
14 SourcesVerywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.American Medical Association.CPT (current procedural terminology).American Academy of Professional Coders.What is CPT?American Medical Association.CPT® code 99213: Established patient office visit, 20-29 minutes.Medicare Coverage Database.Billing and coding: Psychiatry and psychology services.American Academy of Professional Coders.CPT® 81002, under urinalysis procedures.American Academy of Professional Coders.CPT® 85025, under hematology and coagulation procedures.Tsai Y, Zhou F, Lindley MC.Insurance reimbursements for routinely recommended adult vaccines in the private sector.Am J Prev Med. 2019;57(2):180-190. doi:10.1016/j.amepre.2019.03.011Centers for Medicare & Medicaid Services.HCPCS - general information.Centers for Medicare and Medicaid Services.ICD-10.World Health Organization.International classification of functioning, disability and health (ICF).MedPac.gov.Hospital acute inpatient services payment system.U.S. Food and Drug Administration.National drug code directory.CDT:Dental Procedure Codes. American Dental Association.American Psychiatric Association.Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition. Arlington, VA: American Psychiatric Association.
14 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.American Medical Association.CPT (current procedural terminology).American Academy of Professional Coders.What is CPT?American Medical Association.CPT® code 99213: Established patient office visit, 20-29 minutes.Medicare Coverage Database.Billing and coding: Psychiatry and psychology services.American Academy of Professional Coders.CPT® 81002, under urinalysis procedures.American Academy of Professional Coders.CPT® 85025, under hematology and coagulation procedures.Tsai Y, Zhou F, Lindley MC.Insurance reimbursements for routinely recommended adult vaccines in the private sector.Am J Prev Med. 2019;57(2):180-190. doi:10.1016/j.amepre.2019.03.011Centers for Medicare & Medicaid Services.HCPCS - general information.Centers for Medicare and Medicaid Services.ICD-10.World Health Organization.International classification of functioning, disability and health (ICF).MedPac.gov.Hospital acute inpatient services payment system.U.S. Food and Drug Administration.National drug code directory.CDT:Dental Procedure Codes. American Dental Association.American Psychiatric Association.Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition. Arlington, VA: American Psychiatric Association.
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
American Medical Association.CPT (current procedural terminology).American Academy of Professional Coders.What is CPT?American Medical Association.CPT® code 99213: Established patient office visit, 20-29 minutes.Medicare Coverage Database.Billing and coding: Psychiatry and psychology services.American Academy of Professional Coders.CPT® 81002, under urinalysis procedures.American Academy of Professional Coders.CPT® 85025, under hematology and coagulation procedures.Tsai Y, Zhou F, Lindley MC.Insurance reimbursements for routinely recommended adult vaccines in the private sector.Am J Prev Med. 2019;57(2):180-190. doi:10.1016/j.amepre.2019.03.011Centers for Medicare & Medicaid Services.HCPCS - general information.Centers for Medicare and Medicaid Services.ICD-10.World Health Organization.International classification of functioning, disability and health (ICF).MedPac.gov.Hospital acute inpatient services payment system.U.S. Food and Drug Administration.National drug code directory.CDT:Dental Procedure Codes. American Dental Association.American Psychiatric Association.Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition. Arlington, VA: American Psychiatric Association.
American Medical Association.CPT (current procedural terminology).
American Academy of Professional Coders.What is CPT?
American Medical Association.CPT® code 99213: Established patient office visit, 20-29 minutes.
Medicare Coverage Database.Billing and coding: Psychiatry and psychology services.
American Academy of Professional Coders.CPT® 81002, under urinalysis procedures.
American Academy of Professional Coders.CPT® 85025, under hematology and coagulation procedures.
Tsai Y, Zhou F, Lindley MC.Insurance reimbursements for routinely recommended adult vaccines in the private sector.Am J Prev Med. 2019;57(2):180-190. doi:10.1016/j.amepre.2019.03.011
Centers for Medicare & Medicaid Services.HCPCS - general information.
Centers for Medicare and Medicaid Services.ICD-10.
World Health Organization.International classification of functioning, disability and health (ICF).
MedPac.gov.Hospital acute inpatient services payment system.
U.S. Food and Drug Administration.National drug code directory.
CDT:Dental Procedure Codes. American Dental Association.
American Psychiatric Association.Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition. Arlington, VA: American Psychiatric Association.
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