Guide for Medical Billers/Coders on ICD-10 Codes versus CPT Codes

If you have ever considered a medical billing and coding career, you likely have come across the terms ICD-10 and CPT codes by now. These codes form the building blocks of what medical billers and coders use daily to ensure that healthcare providers get paid and patients’ records remain accurate. But what do the two codes mean, and how different are they? This complete guide breaks everything down for you and is explained in plain language so you can understand.

What Are ICD-10 Codes?

ICD-10 stands for the International Classification of Diseases, 10th Revision. These codes are used to classify and code all diagnoses, symptoms, and procedures in health care. Developed by the World Health Organization, ICD-10 codes allow for uniform reporting of medical conditions so that doctors, hospitals, and insurance providers can understand and communicate what an individual has.

Codes are a combination of numbers and letters, making the ICD-10 alphanumeric. For example, a common cold receives the code J00. The sort of illnesses or diseases that the codes reflect can vary from very minor to very dire. Over 70,000 currently applied ICD-10 codes exist, signifying how vast this system is.

What Are CPT Codes?

CPT is the abbreviation for Current Procedural Terminology. While ICD-10 codes reflect a patient’s diagnosis, CPT codes find their use in explaining procedures and services performed by healthcare providers. The American Medical Association maintains these and finds their applicability within the United States.

The five-digit CPT codes ensure that a healthcare provider gets fully reimbursed for a service. For example, the number used for coding the usual physical would be 99381. Approximately 10,000 such CPT codes cover everything from a check-up examination to very complicated surgeries.

ICD-10 vs. CPT: What’s the Difference?

The main difference between an ICD-10 and a CPT code is what is defined. An ICD-10 code establishes a patient’s diagnosis or condition—anything from a broken arm to diabetes. A CPT code defines what services or treatments were rendered to maintain, diagnose, or cure that patient’s condition now that they are in the diagnosis—for example, setting a broken bone or running a blood test. ICD-10 describes what is wrong with the patient, and CPT describes what was done to help them.

For example, a patient visited the doctor because of a sore throat. The ICD-10 code might be J02.9, indicating an unspecified acute pharyngitis. A CPT code might be 99213, indicating an office or other outpatient visit to evaluate and manage an established patient.

Both types of codes are critical to medical billing and coding. They work in coordination and provide a complete picture of the patient’s visit, which enables a healthcare provider to be paid correctly and have an accurate medical record of the patient.

Why are These Codes Important for Medical Billers and Coders?

Medical billers and coders are a crucial part of the healthcare system since they ensure that service providers get adequate revenue for providing services; concurrently, their expertise guarantees the accuracy of the patient data. An understanding of the ICD-10 and CPT codes is required to be able to do their job, as these codes serve as a type of language used in communication by healthcare providers, insurance companies, and government agencies.

As stated by the U.S. Bureau of Labor Statistics, the employment growth rate for medical billers and coders from 2021 to 2031 is projected to rise by 8%, with an increase that will yield over 30,000 new jobs. There are many Reasons for the growth and the need for accurate medical documentation as the landscape continues to move to electronic health records. 

Coding errors could result in critical issues, such as total claims being rejected, delayed payment, or even legal matters. That is why I possess the attribute of maintaining a good knowledge of the ICD-10 and CPT codes by a medical biller or coder. When the expert masters these codes, the activities in the healthcare system will run smoothly, allowing patients to receive optimal care.

Tips on Learning ICD-10 and CPT Codes

1. Practice regularly: The more you use these codes, the more familiar you will become with them. Practice will enable you to identify the correct codes in real-life situations effortlessly.
2. Be Current: ICD-10 and CPT codes change frequently. Stay abreast of all changes and Revisions to stay proficient. 
3. Use Reliable Resources: Some online resources and textbooks will guide you through learning ICD-10 and CPT codes. 

Northwest Career College is the perfect place to seek solutions whenever you’re ready to turn your healthcare passion into a rewarding career. The high caliber of the course bestows full training in the ICD-10 and CPT code values, furnishing the capability to make suitable health choices as an assured quality biller and coder. We will support your pathway for those just starting, advancing, and returning. Get on the path toward a fulfilling career by enrolling with us today!