What Are The Differences Between CPT and ICD Medical Codes

Medical coding is a critical part of the healthcare system's billing and payment structure. Insurance companies rely on codes to tell them what they are being billed for. Healthcare providers utilize them in lieu of having to write things out in detail. When the codes are applied correctly, everyone is happy.

To the medical coding specialist, getting it right is non-negotiable. Coders rely on multiple coding sets to do what they do. The two most commonly utilized sets are as follows:

• Current Procedural Terminology (CPT) codes
• International Classification of Diseases (ICD) codes

Experienced medical coders can talk among themselves and use codes from the two sets without issue. They know exactly what is being discussed. But for the rest of the population, it is all Greek. Most people have no idea that CPT and ICD medical codes are completely different in both scope and implementation.

CPT Code Basics

Between the two code sets, CPT is arguably utilized more often. The codes in this set represent medical procedures and services provided by doctors, hospitals, diagnostic clinics, independent labs, etc. Given the number of possibilities across the entire healthcare spectrum, CPT offers coding specialists a lot to work with.

CPT codes cover everything from in-office consultations to lab tests to surgical procedures. In some cases, the codes can apply to diagnoses. When that happens, they can overlap with ICD codes. This can create confusion that leads to coding errors.

ICD Code Basics

When medical coding specialists are dealing with ICD codes, they are dealing with medical diagnoses. ICD codes represent the full spectrum of injuries, illnesses, and maladies patients are diagnosed with. However, application of the codes is not always cut-and-dried. A given diagnosis can often be coded multiple ways depending on contributing factors.

In some cases, ICD codes are a matter of interpretation. A patient could see two doctors for the same condition, wind up with different diagnoses, and have those diagnoses quoted differently. That is the nature of the business. It is up to the coding specialist to figure out the most appropriate code in a given scenario and assign it to the diagnosis.

ICD-10 is the current standard for diagnostic codes. It represented a vast improvement over ICD-9 when it was first released years ago. That said, ICD-11 is now available as well. Its use is not mandated, but ICD-11 does expand the total number of codes available to coding specialists.

Knowing How and Where to Find Them

There could be more than 100,000 different codes across all the many code sets our healthcare system works with. It is not reasonable to expect medical coders to memorize them all. In fact, there are only a comparatively small number of codes that become so familiar to a coder that looking them up isn't necessary. For all the rest, it is a matter of knowing how and where to look them up.

Before the internet era, medical coders had stacks of manuals to look through. Looking up medical codes was a lot like using a dictionary. It wasn't especially difficult, but it was time-consuming. The internet has changed all that. Now, medical coders can look up most of what they need to know online.

An experienced coder is intimately familiar with both CPT and ICD codes. They know that the former relates to procedures and services while the latter refers to medical diagnoses. Keeping the two separate in the coder's mind makes it easier to properly assign codes so that bills can be submitted. It is all in a day's work for professionals whose livelihood depends on getting it right.

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