The job of a coder is full of challenges, stress, and confusion. Its requires you to be swift, accurate, and clear; or else you might face a DENIAL-a much dreaded word and one that every coder would probably want to remove from his or her dictionary. If you are new to this world and have not undergone any training, life might be a little difficult for you. But worry not and read on for an introduction to the codes you’ll be required to use.As a coder, you shall have access to printed or online copies of CPT® and ICD-9 manuals. If not, ask for them right now from your manager. Let us have a look at what these manuals are, and what are the codes you need to “code” or report to the insurance agencies and/or Medicare.CPT® codesCurrent Procedural Terminology codes, more commonly known as CPT® codes, are 5-digit numeric codes. These are developed and maintained by the American Medical Association (AMA) and are used by the coders and billers to report the services-to Medicare or private insurance agencies-that a physician provides to a patient.Insurance providers reimburse the healthcare professions for these services on the basis of the CPT® codes reported. Therefore, report the correct code and explain medical necessity, wherever required, to get the deserved reimbursement.Going through your 2013 CPT® manual, you’ll find that CPT® 2013 are divided into three sections:• Category I: These consist of:a) E/M (Evaluation and Management) codes, from the series: 99201-99499;
b) Anesthesia codes, from the series 00100-01999 and 99100-99150;
c) Surgery codes, from the series 10021-69990;
d) Radiology codes, from the series 70010-79999;
e) Pathology & Laboratory codes, from the series 80047-89398;
f) and Medicine codes, from the series 90281-99199 and 99500-99607• Category II: These are optional, supplemental tracking alphanumeric codes that help measure performance.• Category III: This category consists of temporary codes that describe new technology, procedures, and services.ICD-9 CodesICD, or International Statistical Classification of Diseases and Related Health Problems, provides alphanumeric codes to classify diseases, and report symptoms, injuries, diseases, and conditions. This set is updated at least once a year based on the feedback given by the providers and payers. There are no however no ICD-9-CM changes for 2013, as there’s a freeze in place until ICD-10-CM replaces the ICD-9 in October 2014.The ICD code set comprises:• Volume 1: This is a numeric list that classifies diseases by their cause (etiology) and their analysis (anatomy).
• Volume 2: This is a numeric list alphabetic index that coders use to find codes in Volume 1.
• Volume 3: This is a procedural classification that has a tabular section and an index. It is generally used only by hospitals.ICD codes are similar to CPT® codes, except that the latter identifies the services provided while the former explain the diagnosis on the claim form.