REIMBURSEMENT Codes are the alpha-numeric language by which hospitals and physicians communicate to insurers what procedures were performed and why they were performed. Several types of codes exist, and not all new medical technologies require a new code. Below is a brief list of the types of codes, the organization that manages the codes, and the associated link that provides the application and/or explains the process involved in obtaining a new code. RCRI® emphasizes that careful consideration must take place prior to applying for a new code. For more detailed information, please contact Monica Schultz, Director of Reimbursement, at 952-746-8721, or email at mschultz@rcri-inc.com.ICD-9-CM Procedure CodesInternational Classification of Diseases, 9th edition, Clinical Modification (ICD-9-CM) codes are managed by Centers for Medicare and Medicaid (CMS). Two types of ICD-9- CM codes exist:
Diagnosis codes are used to describe what disease or injury the patient suffers from, and thus justifies the procedure performed. Diagnosis codes are used on all types of provider bills, including inpatient, outpatient, and physician office settings.
Procedure codes are used to describe what was done for the patient. ICD-9-CM procedure codes are used to bill for inpatient hospital procedures. CPT-4 Procedure
Physicians Current Procedural Terminology, 4th edition, (CPT-4) codes are managed by the American Medical Association (AMA). These codes are used by physician offices to bill for physician services. They are also used by outpatient clinics to bill for outpatient procedures. As in all settings, these codes must be accompanied by an ICD-9-CM diagnosis code to justify the procedure. CPT codes are a subset of HCPCS codes (see below).
HCPCS II
The Healthcare Common Procedural Coding System (HCPCS) Level II codes are managed by the HCPCS National Panel, members of which represent Blue Cross and Blue Shield Association, the Health Insurance Association of America, and CMS. HCPCS Level I codes are CPT-4 codes (see above). HCPCS Level II codes are used to bill drugs, dental procedures, durable medical equipment, orthotic and prosthetic procedures, and other services.
NOTE: The information on this website is provided as background information only. Reimbursement strategy relies on more information and context than can be provided on one website. Therefore, Regulatory and Clinical Research Institute, Inc. specifically disclaims liability or responsibility for the results or consequences of any actions taken in reliance on information from this website.
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