What is the difference between ICD and CPT for medical coding?

Medical coding has become a very important part of the healthcare services. Medical coders and billers are responsible for coding the documents necessary for the doctor to receive payment from the medical insurance providers. These professionals undergo extensive training, in order to successfully follow this process. A certification from an accredited organization is also helpful in obtaining future employment in the field. While it is not necessary, it is highly recommended to acquire a certification before applying for a position as a medical coder. Employers prefer the certified coders over non-certified coders. Additionally, it will show your future employer your dedication towards the profession. Obtaining qualification makes a positive impact on your resume and increases your odds of getting hired. The same results were shown when a research was conducted by AAPC; the final results proved that the average income of a certified coder is 20% to 30% more than non-certified coders.

 Most organization and medical insurance companies have their own requirements for filling out the forms and codes, which can be very confusing and frustrating for the patient, himself and his family. This is where the medical coders come in. The medical coders are specifically  trained to deal with these codes and help in making the payment process, faster and easier. Manual codes are also provided in order to make the payment process fast, as well as assists the patient in understanding the medical problem.

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CPT, the ‘Current Procedural Terminology’ and ICD, the ‘International Classification of diseases’ are the two types of manual codes are used by the medical coders and billers.

Kristy Feldmen
Senior Editor

The following summarizes each of these codes, in order to understand the difference.

  • The CPT codes are used to report various medical procedure and services taken into account by the physician during their treatment period. The services can range from anything related to mere diagnosis, to surgery, laboratory tests or radiology. Each code is described in the CPT book and deciphers the procedure followed by the doctor during the consultation. Simply put, it outlines what exactly was done to the patient while consulting. It also describes the medical services done by the doctor. A CPT code acts as a communication bridge between the patients, physician and the insurance companies, and provides a uniform format to describe the diagnostic and treatments procedures performed on the patient. CPT codes are then used by the insurance companies to decide the fee for physician’s services. AMA, the ‘American Medical Association’ maintains and holds all the copyrights for this ‘U.S. standard coding and billing’ medical procedure.
  • The ICD codes are used to describe a disease and identify the diagnosis of a particular medical condition.Once the physician identifies the problem, a diagnosis code is assigned to the patient, which can be found in the ICD code books; ICD-9 or ICD-10. It aims towards describing the exact problem or disease that a patient is suffering with, so that the patient, physician as well as the insurance provider can better comprehend the medical condition under treatment.The ICD codes are recognized and accepted internationally. It was developed by the ‘World Health organization’- (WHO), who is also responsible for monitoring,maintenance and holds all of its copyrights. The ICD codes are written in the form of alphanumeric characters that can be applied to any symptom, diagnosis and cause of death. Since these alphanumeric codes follow an international standard, they can be recognized  easily by any physician, patient and medical insurance provider whether in U.S. or in any other country. The ICD-9 version of these alphanumeric codes is currently used in United States; however, more physicians and insurance organizations are now replacing it with the ICD-10 version. ICD-10 is more complex and longer than the ICD-9 version and describes the codes more comprehensively. The appearance of symptoms is also recorded, for example, which symptom appeared first and on which side. It also eliminates the risk of running-out of possible codes for diseases and diagnosis. 
  • CPT ranks higher than ICD in terms of complexity. For instance, any particular disease or medical condition will have only one ICD code. However, in order to describe it in CPT code, you would have to determine the situation of the patient, when he/she visits the doctor for consultation. The total time spent for consultation and diagnosis and even the number of vital systems examined by the physician, makes the process of assigning a code rather complex. 

  • The total number of codes published in a ‘Current Procedure Terminology’ book is 800, whereas the total number of codes published in an ICD-9 and ICD-10 version book are 24,000 and 200,000 respectively. 

  • The CPT book consists of a ‘common procedure coding system’ for health care services, and focuses on all the expenses, as well as the equipment and medication charges included in the bill. There is no such system found in either version of the ICD books. 

  • The CPT books are updated every three to five years whereas the ICD books are updated, every 10 to 15 years.

In addition to this, the insurance companies pay the doctors based on the CPT codes that they submit. However, a CPT code cannot be submitted alone, it must be attached with a CPT claim along with the ICD codes. The ICD code is necessary because it also describes the cause of visit. Thus, an ICD code is necessary for every meeting, be it for colonoscopy, CT scan, eye-test, or just a simple check-up visit to the physician’s office. In other words, your documentation will be complete only if it contains both the CPT and ICD codes.

The ICD codes are also being used in a program called the PQRS program- ‘Physician Quality Reporting System’ wherein they are used in a combination with particular CPT codes. It has been reported that the physicians who do not participate in the PQRS program will be charged a minimum of 1.5% of all their Medicare fee and charges.

Kristy Feldmen
Senior Editor

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