If you have ever reviewed a workers compensation medical bill and saw what is referred to as an ICD-9 code or a CPT code and wonder what the codes mean, you are not alone. Both the CPT codes and the ICD-9 codes are numerical ways used to communicate within the medical community.
The ICD-9 codes are used to describe the medical diagnosis.
The CPT codes are used to describe what medical procedures were provided to the patient.
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1- The International Statistical Classification of Diseases and Related Health Problems (abbreviated to ICD) is used for the diagnosis of medical conditions. The ICD codes are published by the World Health Organization (WHO) and are used world-wide for morbidity and mortality statistics.
2- The ICD-9 abbreviation stands for the International Classification of Diseases, the ninth edition. Per the WHO, the system is used to “classify diseases, signs and symptoms, abnormal findings, complaints, social circumstances and external causes of injury or disease”. The ICD-9 codes start at 001 and go through 999. The most common ICD-9 codes seen in work comp are the codes 800 to 999 which are used for “injury and poisoning”. In addition to the numbers 001 to 999, there are codes E000 to E999 which are for the Supplementary Classification of External Causes of Injury and Poisoning, and codes V01 thru V91 for Supplementary Classification of Factors Influencing Health Status.
3- The American Medical Association (AMA) publishes the copyrighted Current Procedural Terminology (CPT) codes. Per the AMA, the CPT codes are intended as a way for medical providers to have a consistent description for the medical, diagnostic and surgical services.
4- The CPT codes are five digits numbers from 00100 to 99499. CPT code 00100 is used for an anesthesia service. CPT code 99499 is a miscellaneous code used for “unlisted evaluation and management services”. This code is normally used by nurse practitioners, physician assistants and other non-physicians to bill for a lesser level of service.
5- All the numbers between 00100 and 99499 are not used. Only about 7,800 codes are used to depict the medical, radiological, anesthesiology, laboratory, surgical and evaluation/management services of doctors, hospitals, physical therapist and other medical providers.
6- On occasion the 7,800 CPT codes are not enough. If there is an unusual situation, a two digit modifier, either numerical or alpha are used to explain the unusual situation. The numbers from 22 through 99 may be used to explain additional medical services provided. Not all numbers between 22 and 99 are used, only about 30 two digit numbers are used. In addition to numbers there about 25 alpha codes from AA to US that can be used as a modifier.
7- If you are beginning to think this system of ICD-9 codes for diagnosis and CPT codes for medical procedures is a bit complicated, you are right. The AMA recommends that only medical personnel with the proper credentials and training assign the ICD-9 codes and CPT codes.
8- By having a systematic classification of diagnosis and procedure codes, medical personnel can review the coding and quickly understand both the diagnosis and medical treatment provided to the injured employee by other medical providers. In addition to the communication between medical providers, the ICD-9 and CPT codes allow for uniformity in billing by all medical providers.
9- The ICD-9 codes and CPT codes are incorporated into the medical fee schedules for workers compensation used in most states. They are also utilized by health insurance companies and CMS (Centers for Medicare and Medicaid Services) for the pricing of medical billing.
10- In future, we will have ICD-10, the tenth revision. It has more than 14,400 diagnosis codes. It was originally slated to be put in use in the United States on October 1, 2011. The implementation of ICD-10 has been pushed back to October 1, 2013 due to issues CMS has had with the implementation.
Author Rebecca Shafer, JD, President of Amaxx Risks Solutions, Inc. is a national expert in the field of workers compensation. She is a writer, speaker, and website publisher. Her expertise is working with employers to reduce workers compensation costs, and her clients include airlines, healthcare, printing/publishing, pharmaceuticals, retail, hospitality, and manufacturing. See www.LowerWC.com for more information. Contact: RShafer@ReduceYourWorkersComp.com or 860-553-6604.
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