Medical coding terminology can be intimidating, but it doesn’t have to be.
Medical billers and coders must be familiar with medical coding terminology, including names of conditions and illnesses, treatments and medications, and medical code vocabulary. Our team remains updated with changing coding standards as an experienced medical billing and coding company in the United States. They understand billing and coding terminologies and vocabulary, diseases with their diagnosis and treatment options.
As you learn more about coding, there are a few key terms you should become acquainted with. Let’s take a look at some of them now.
CPT is an abbreviation for Current Procedural Terminology. The American Medical Association maintains the Current Procedural Terminology (CPT) code set through the CPT Editorial Panel, a set of medical codes used to report medical, surgical, and diagnostic procedures and services. These codes are also used in administrative management, such as claim processing and developing guidelines for medical care review.
The CPT code set is divided into three components:
Category I: The most commonly used codes describes medical procedures, technologies, and services.
Category II: This category is used for performance management and additional data.
Category III: Houses the codes for emerging, experimental medical procedures and services.
International Classification of Disease codes(ICD) helps in classifying diseases, injuries, and causes of death. These codes ensure proper treatment and charging for all medical services rendered. The World Health Organization (WHO) maintains the ICD code set, which is distributed in countries worldwide.
The National Centre for Health Statistics created this designation, which is added to the ICD code sets when they are implemented in the United States. Many countries expand and clarify ICD code sets for national use; for example, the United States expanded ICD-10 from 14,000 to over 68,000 individual codes.
Evaluation and Management (E/M) Codes:
E/M coding is the use of CPT® codes from 99202 to 99499 to represent services provided by a physician or other qualified healthcare professional. As the name implies, these medical codes apply to visits and services that involve analyzing and maintaining patient health. Private health insurance companies have adopted it as the standard guidelines for determining the type and severity of patient conditions. That enables medical service providers to document and bill for services rendered.
Codes for services such as surgeries and radiologic imaging are found outside of the CPT® code set’s E/M section.
A modifier is a two-character code that is appended to a procedure code to show an important variation that does not change the definition of the procedure on its own. HCPCS codes have alphanumeric modifiers, whereas CPT codes have numeric modifiers. These are placed at the end of a code with a hyphen and may contain information about the procedure itself, its Medicare eligibility, and various other important details.
EOB stands for an explanation of benefits. It is a detailed statement from your health insurance company based on payment for a medical billing service you received. It explains which services were covered by your insurance plan and which you are responsible for paying.
When you consult a health care provider, you will be asked if you want the treatment billed to your insurance. The medical office should file a health insurance claim with your insurance company if you do. That is a claim to your insurance company for payment to meet the visit, treatment, or equipment expense. When your health care provider submits a claim on your behalf, your insurance company sends it to you. Make sure you understand every line of your EOB when you read it. Use it to keep track of your expenses and ensure no billing mistakes.
When the insurance company receives the claim, they will assess it, prepare an Explanation of Benefits, and mail it to you. They may also make a digital version available on their website. Whether you have private insurance, employer-provided insurance, or Medicare, you should receive an EOB. You should receive an EOB for each service you received, regardless of whether you owe anything for the service. You will receive an EOB for each service you got or for the same service performed on different days.
AR stands for accounts receivables. Accounts receivable is a corporate asset that represents the amount of money due to you by unpaid customers. Even if the company has not yet received the money, AR symbolizes its value. Accrual-basis accounting acknowledges income just as cash-basis accounting does when it is earned rather than paid. In general, when both parties honor the deal’s conditions, the AR is converted into bankable cash. If a receivable account is not converted into payment on the client-side of the transaction, the value of the AR may decrease.
A provider should send you a notice before receiving service if your provider has reason that Medicare will not pay for the service based on Medicare coverage criteria is known as Advance Beneficiary Notice (ABN). You may receive an ABN if you have Original Medicare, otherwise you have a Medicare Advantage Plan. The ABN may differ based on the source which provides it to you. The ABN enables you to choose whether or not to receive the care in question and bear financial responsibility for the service on your own If Medicare denies reimbursement. The note must state why the provider believes Medicare will refuse payment.
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