Medical coding and billing is a lucrative career with excellent job security for the foreseeable future.
At the same time, it takes a while to understand how to apply medical diagnostic codes. The system is pretty confusing for newcomers.
Relax: you don’t have to remember every code. In fact, once you start working, you’ll have plenty of resources at your disposal to research the codes you need.
After a while, you’ll start memorizing the most frequently used codes at the office (or offices) you work. When a new code pops up that you’ve never used before you’ll probably get excited to tell all your coding friends about it.
As for now, here’s what you should know about learning diagnostic and procedure codes.
Why Should You Learn Medical Diagnostic Codes?
The Bureau of Labor Statistics expects jobs in the financial clerk industry to grow 9% until 2026. This applies to all types of financial clerks but the number is likely to be much higher for medical billers due to the booming healthcare industry.
Diagnostic and procedure codes are the math equivalent for the healthcare industry.
Yes, the healthcare industry also uses math – but remember that math is a universal language.
Medical codes allow doctors, insurance companies, hospitals, and healthcare workers to communicate with each other in a concise yet accurate manner.
Okay, they’re more like shorthand for healthcare.
Although medical codes vary around the world in different countries, they’re standard within each of those countries. So, if you see a doctor in Alaska while you’re on vacation and later transfer your records back home to Florida, your primary care doctor will know exactly what happened.
Working in the healthcare industry, you’ll probably come into contact with medical codes fairly often. As a medical assistant, you’ll need to reference certain codes for the biller to send to the patient’s insurance company.
However, no one deals with medical diagnostic codes more than – you guessed it – medical coders and billers. As a biller, you’ll eat, sleep, live, and breath ICD codes. You’ll see them everywhere you go and in everything you do.
There’s always a code for that – and if there isn’t, it will probably exist at some point. (Just wait until you see what kind of strange medical codes are out there.)
Understanding Medical Diagnostic Codes and Procedure Codes
There are three general types of medical codes you’ll need to familiarize yourself with.
Each type of code covers a different area of the healthcare industry: some focus on procedures in a physician’s office, others describe symptoms, and others manage diagnoses.
International Classification of Diseases: ICD Codes
The World Health Organization (WHO) launched International Classification of Diseases nearly 70 years ago.
This is the set of medical diagnostic codes you’ll get familiar with for identifying illness, injury, and death. WHO has updated ICD codes several times since the initial launch – 11 times to be exact.
As of June 2018, the ICD-11 is available to specific member states, however, ICD-10 is still used in the United States at this time.
One key point to understand about ICD codes is the Clinical Modification – which is labeled as CM at the end of each code. This modification expands the possibilities for codes to make them hyper-specific. That’s exactly why you see so many strange codes out there.
As a medical biller, you’ll use ICD codes to let insurance companies know about the patient’s symptoms and the doctor’s diagnosis.
The insurance companies will then cross reference this code with the procedure code to make sure the diagnosis justifies the procedure – and if it doesn’t, the insurance company will likely reject your patient’s claim.
Get your codes right because your patients’ wallets depend on your accuracy and attentiveness.
Current Procedure Terminology: CPT Codes
While WHO manages ICD codes, the American Medical Association (AMA) manages Current Procedure Terminology codes.
These are the codes you’ll use to describe what took place in the physician’s office after the doctor provided medical diagnostic codes. Did she perform X-rays? Surgery? Bloodwork? Make sure the insurance company gets a bill for all of it by using the correct codes.
CPT codes are divided into categories which correspond to the type of procedure. Many procedures that take place at a physician’s office will fall into the first category which covers things like evaluation, anesthesia, surgery, pathology, and general medicine.
The second category contains codes for radiology and lab test analysis – you'll use this category much less often than the first.
Like ICD codes, you can modify your procedure codes via the last digits to provide specific information.
Healthcare Common Procedure Coding System: HCPCS Codes
The AMA also manages a set of procedure codes called HCPS codes – but you’ll probably hear them called “hick picks” around the office or in your online coding circles.
Although they’re similar to CPT codes, HCPCS codes reference a specific set of procedures. This might involve chemotherapy, prosthetics, and ambulance rides as well as specific medical equipment and medications.
If you’re working at an outpatient clinic, familiarize yourself with the basics of HCPCS because you’ll use these codes for almost all the procedures performed at your office.
Also, HCPCS codes are most frequently used for patients with Medicare or Medicaid insurance plans. It can get a little confusing deciding whether to use HCPCS or CPT codes but you’ll get used to it fairly quickly.
Just remember that the burden falls on you to ensure the proper procedure codes are sent to the insurance company for billing – every time. Failure to use the right codes on your first shot could result in the patient getting a costly bill in the mail – and you (the biller) getting a call from an outraged patient.
Healthcare Common Procedure Coding System: HCPCS Codes
If you’re new to the medical coding and billing scene, you might not realize that there is a slew of strange, unusual, and downright hilarious codes out there.
There’s really a code for everything. Here are some of the strangest medical diagnostic codes you might come across in your new line of work.
- 1222D Fall in (into) bucket of water causing other injury, subsequent encounter Not a pool – a bucket – and it wasn’t the first time the doctor treated the patient for this problem.
- 2Y92146 Hurt at swimming pool of prison as the place of occurrence Apparently this happens so often they had to write a code for it. Also: prisons have pools?
- 34 Inadequate social skills, not elsewhere classified Ouch. Thanks, doctor.
- 4D1 Knitting and crocheting All those pointy needles – it makes sense but it’s still funny.
- 52 Accidental twist by another person Of course, happens all the time.
- 6867A Insect bite (nonvenomous) of anus, initial encounter Sympathies to anyone whose doctor has had to use this code. At least it was nonvenomous.
- 700XS Unspecified balloon accident injuring occupant, sequela Which type of balloon are we talking here?
- 841XA Spacecraft crash injuring occupant, initial encounter Blame Elon Musk for this one.
- 91 Bizarre personal appearance But how exactly do you define “bizarre?”
- 10Z631 Problems in relationship with in-laws Where do we draw the line between inconvenience and medical problem?
Get ready for anything because as a medical biller – especially one working online – you'll literally see it all.
Starting Your Coding and Billing Career
You’re ready to start your career as a medical biller but first you need to make it through your education and training.
You have three different training and certification options for gaining leverage over other job applicants – the more certifications the better.
- 1Certified Professional Biller (CPB): Certification related to submitting claims and posting payments.
- 2AAPC Medical Coding and Billing Training: The most widely recognized certification for entry-level coders and billers.
- 3Certified Professional Coder (CPC): Specific training and certification for physician offices.
Many people want to know what the most important codes are – what should they memorize? Well, that answer depends on the setting you plan to work. If you’re working at a surgical center or hospital, you’ll find yourself memorizing many different codes than your comrades at a general practice office.
Even within a hospital, the codes you use on a daily basis will depend on the department you work in. Working in obstetrics will involve many similar codes relating to pregnancy symptoms and procedures. Meanwhile, those working on oncology will use an entirely different set of codes as part of their daily routine.
Then again, if you work online, you might find yourself coding and billing for several different types of practices – and you’ll probably memorize plenty of different medical diagnostic codes.
Arm yourself with resources from your industry. Your school and training should provide you with access to lists and documents.
Remember that medical codes change – all the time – this is a very dynamic industry so it’s important to stay ahead of the game. Follow newsletters and message boards to stay up to date on ICD changes and updates and new codes.