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New to Medical Billing?

New to Medical Billing?

Understanding the basics of medical billing will make it easier to process claims and do your coding correctly, even if you don’t work in the industry full time or you are new to working in a practice.

You will hear two terms over and over. ICD-9 and CPT. These are the two coding systems that are used to process medical billing forms. The first acronym is the one that identifies the type of disease or physical state of the patient being treated. Those are the ICD-9 codes which stands for International Classification of Diseases, 9th Revision, Clinical Modification, or shortened ICD-9-CM, codes) and another that describes the procedures, services or supplies you provide to your patients (the Current Procedural Terminology, or CPT codes).

To differentiate between these coding systems, think of it this way: CPT codes describe what services you perform, and ICD-9 codes describe why you do it.

With each service that is performed for a patient, a line for a medical billing claim to be submitted to insurance or Medicare is formed. The level of reimbursement is linked to a claim’s CPT codes, you need to record a symptom, diagnosis or complaint (an ICD-9 code) to establish the “medical necessity” of each service. The claim must read logically and show a necessity for each procedure form. Building that link of necessity is one of the most important jobs for a medical biller. Showing medical necessity basically means that you justify your choice of CPT code by linking it to an appropriate diagnosis by using an ICD-9 code.
Up to four ICD-9 codes can be linked to each CPT code on a HCFA-1500 form.

New CPT codes can be released throughout the year and as they are updated, you must change the way your medical billing claims are reported or you run the risk of rejected or denied claims. It’s important to stay informed of not only changes actively being made but also be aware of coming changes to you know if you need to start reporting any procedures in a different manner to insure the best reimbursement possible for your practice.

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