Why Learning To Read Medical Billing Codes Is A Must

by  Find-A-Code™
Apr 19th, 2023

If you are a trained and certified medical coder or biller, we are guessing you know how to read medical billing codes. Reading them is probably second nature if you've been on the job for a couple of years. To someone who is new to the profession though, there may be some confusion as to why learning to read the codes is so important.

This post will look at CPT codes to explain why learning how to read them is a must. The starting point is understanding that there are literally tens of thousands of codes to work with. CPT codes are only one set. Billers and coders also need to deal with ICD-10 codes, NPI lookup, and a whole lot more.

4 Code Categories

As there are so many CPT codes, they are divided into different categories for easier comprehension. The categories are as follows:

• Category I – Codes relating to medical procedures, devices, medications, etc.
• Category II – Codes relating to quality of care and performance measurements
• Category III – Codes pertaining to emerging technologies, services, and procedures
• PLA – Codes pertaining to lab tests.

There are two important things to know about the categories. First, Category I codes are the most often utilized. It is important that coders and billers have a thorough understanding of codes in this category. Second, Category III codes tend to be temporary in nature. Any given code is likely to be dropped when its associated service or procedure is no longer considered emerging.

5-Character Codes

CPT codes contain five alphanumeric characters. Most of them are comprised of five digits, but some have four digits with a letter in the fifth position. Learning to recognize key characteristics of each code group makes coding and billing easier. It makes it more efficient.

For example, all Category I codes ranging from 99202 to 99499 relate to patient evaluation and management. Codes in the 70010-79999 range pertain to radiology procedures. Understanding how Category I codes are arranged and grouped makes it a lot easier to look up unfamiliar codes on the fly. On the other hand, not understanding code groupings can turn the search for an obscure code into a gargantuan task.

Far Too Many to Memorize

Even with the limited amount of information discussed thus far, it should be clear to see that CPT codes are complicated. But more importantly, there are far too many for any medical coder or biller to memorize. Even someone with a photographic memory would be hard pressed to commit all the codes to memory.

Learning to read them is important inasmuch as medical billers and coders spend a lot of time looking codes up. They need to. Knowing how to read the codes makes the task easier. A knowledge of how codes are structured guides every search to its most efficient and timely conclusion.

This explains why new medical coders and billers spend more time looking up codes than their veteran counterparts. Even with the book knowledge gleaned from training and certification programs, learning to efficiently read codes requires real-world practice. It is practice that can only be gained on the job.

Become Code Literate

If you are new to medical coding or billing, we encourage you to treat learning the codes the same way you approached learning to read English. Put the time and effort into becoming code literate. Once you learn how to read medical billing codes, you will find that you are a lot more productive. You will probably be more accurate as well. Learning how to read medical billing codes is a necessary part of the job.