The Health Insurance Portability and Accountability Act of 1996 (HIPAA) identifies medical coding standards used for billing insurance companies. Medical and diagnostic procedures performed in hospitals, medical offices and labs are all billed according to HIPAA standards. Using the appropriate codes and modifiers allows the insurance company to process a claim for payment.
Current Procedural Terminology (CPT)
Set forth by the American Medical Association (AMA), the Current Procedural Terminology (CPT) manual is used for billing medical and diagnostic procedures. The codes consist of a five-digit number that must be placed on an insurance claim form for the company to consider the corresponding charges for payment.
Health Care Common Procedure Coding System (HCPCS)
The Health Care Common Procedure Coding System (HCPCS) is set by the Centers for Medicare and Medicaid Services (CMS). These codes cover non-medical supplies and items not located in the CPT manual. Such items include orthotics, prosthetics and medical supplies. Medications are identified by National Drug Code (NDC) codes that represent the vendor, product and packaging for all medications.
International Classification for Diseases (ICD)
Diagnosis and conditions are represented by codes set forth by the International Classification for Diseases (ICD). These codes have three digits and may be followed by two decimal places to represent medical necessity for procedures. Every CPT code must have an ICD code listed beside it on an insurance claim form. Each diagnosis code may be used in conjunction with multiple procedures.
Modifier
CPT codes occasionally require modifiers. Modifiers are added to offer further information and give the insurance company a precise location. For example, a modifier of RT may be used if an x-ray is performed on the right ankle. Not using the correct modifier could result in a claim being denied by the insurance company.
Corrected Claim
If a claim is rejected by an insurance company for incorrect coding, a corrected claim is filed. The codes are corrected, and then any supporting documentation, such as medical records, is attached to the claim form. The claim is marked "corrected claim" and rebilled to the insurance company for reconsideration.
Tags: insurance company, claim form, Care Common, Care Common Procedure, , Coding System, Coding System HCPCS
