The Joy of Deciphering Medical Billing Codes

by  Find-A-Code™
Aug 10th, 2022

As someone who deals with medical billing codes for a living, you pretty much know what they mean. Even if you don't know the details of every single code you work with, you at least understand how they are structured. Imagine a typical patient who has no idea about how medical billing codes work. Deciphering them is nothing short of a nightmare.

It doesn't hurt that there are over 55,000 codes just in the ICD-11 catalog alone. Trying to make sense of it all is enough to drive anyone batty. No wonder good medical billers are so valuable to the healthcare sector.

3 Categories of Codes

Here in the U.S., our healthcare system divides medical billing codes into three categories. They are one of the first things addressed in medical billing training. The three categories are:

●    International Classification of Diseases (ICD-10-CM)
●    Current Procedure Terminology (CPT)
●    Healthcare Common Procedure Coding system (HCPCS).

The first two categories are the most important to the U.S. system. ICD codes relate to a patient's diagnosis. Interestingly, the codes are not used exclusively for billing purposes. Healthcare facilities often use the same codes on charts and patient medical records. At any rate, ICD codes essentially describe the diseases, injuries, and maladies patients are suffering with.

CPT codes are all about medical procedures and treatments. They relate to things like surgeries, diagnostic tests, and prescription medications. A CPT code tells an insurance company how the patient is being treated for a particular problem.

Letters and Numbers

Nearly all medical billing codes are a combination of letters and numbers. For the longest time, the healthcare system relied on the ICD-10 catalog for classifying diseases and injuries. ICD-11 came along a few years ago. It hasn't been fully implemented yet, but the new system is well on its way.

Under ICD-10, medical billing codes consist of a letter and three digits, with a decimal point after the second digit. The letter designates the disease category. For example, 'C' designates cancer. The numbers following the letter specify the particular condition.

The new system follows a similar structure but with a few changes. First, the letters 'I' and 'O' have been discontinued in order to eliminate confusion with the numbers 1 and 0. Next, the letter in an ICD-11 code is preceded by a digit. This new structure is meant to improve accuracy even as the database continues to expand with new entries.

You Can't Remember Them All

The U.S. healthcare system now has to deal with more than 100,000 medical billing codes in total. It is not possible to remember them all unless you are blessed with an incredible memory. That's where organizations like ours come in. We maintain up-to-date databases covering all the medical billing codes you need to do your job. You remember the most common ones; we keep track of the rest.

Services like ours are important to medical billing. Billing specialists rely on the ability to look up codes they can't remember. And when a particular illness or procedure could overlap with another, being able to clear things up with a database search sure makes things easier.

Unfortunately, having to deal with so money different medical billing codes does tend to make the system complicated. But there is no fighting it. Medical billing in the U.S. is well established. It shows no signs of being simplified, either.

If you are a medical biller, you probably understand billing codes better than anyone else. To the rest, it is all Greek. Trying to decipher billing codes on invoices and monthly statements is a fool's errand.