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3 Billing Codes Every Physician Should Know

Medical Billing Codes are a crucial part of RCM or Revenue Cycle Management which enables the communication between medical practitioners and insurers.nnPhysicians and other practitioners are always looking for different ways to increase revenue. One of the basic ways that medical providers miss out on generating revenue is by not billing for services that are provided. nnCoding mistakes are common, whether from a lack of understanding of using the right codes at the right time or having a lack of knowledge about certain codes.nnIn this blog, we talk about what medical coding is and the different types of codes we see today. We also look at 3 codes that are often underrated or are often unknown to the billing staff. nnThis should be avoided, as knowing about the codes, and how to use them, can earn medical firms a decent amount of income that was previously missed.n

Medical Coding 

nMedical coding is a technological advancement that has made the medical process so much simpler than it used to be before. nnMedical codes translate huge reports into codes used within the healthcare industry. Summarising often piled-up medical reports into efficient codes.nnA medical coder is responsible for translating huge medical reports of physicians into medical codes. These people work behind the scenes in different settings, ensuring all appropriate information is coded consistently and accurately. nnAfter a patient is treated by a medical provider, the process of billing starts where the insurance company needs to understand what medical service was provided to further process the bill. nnTo make things simpler and have a common language, specific codes are entered into the software to give the insurance company accurate details. nnThe role of a medical coder is basically to provide the information in a way that is easy to understand and effective.nnThere are the three main codes used today: Current Procedure Terminology (CPT), International Classification of Diseases (ICD), and Health Care Procedural Coding System HCPCS. The code sets help coders to document the condition of a patient and also describe the procedures performed on the patient.n

Different Types Of Medical Codes


ICD-International Classification Of Diseases

nThe ICD was designed as a health care classification system that provided diagnostic codes that classified diseases, including classifications of different symptoms, and external causes of the illness or injury.nnThe ICD is a system developed by the World Health Organization (WHO) and ten international centers in collaboration. nnThe idea was that the medical terms and bills reported by physicians examiners can group them for statistics. In the US, the National Center for Health Statistics manages any alterations to the codes alongside the WHO.n

CPT (Current Procedural Terminology)

nCPT codes offer doctors and professionals a language for coding their medical services and procedures to make reporting efficient and increase accuracy.nnAdministrative management, like claims processing and guidelines for medical care reviews, also uses CPT codes. The terminology used in CPT is the most widely accepted across the country which helps in reporting medical, radiology, surgical, anesthesiology, laboratory, evaluation, and management services under public and private medical insurance programs.nnCPT codes contain five digits which are either numeric or alphanumeric, depending on the category of the medical service. CPT code descriptors utilize common standards so that users have a common understanding of the clinical health care model.n

HCPCS (Healthcare Common Procedure Coding System)

nHCPCS or Healthcare Common Procedure Coding System is another coding system used across the US. nnThe Healthcare Common Procedure Coding System is a collection of codes that represent procedures, products, supplies, and services that are provided to Medicare receivers and people enrolled in private medical insurance programs. The HCPCS codes consist of Level I, II, and III codes.n


  • Level I codes are the AMA’s CPT codes which are numeric.
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  • Level II codes are the alphanumeric code sets. These primarily include non-physician products and procedures.
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  • Level III codes or HCPCS local codes were developed by Medicaid agencies, and private insurers, and are used in specific programs included in the HCPCS coding book. These codes are preferred by payers compared to the Level I and Level II code sets. However, Level III codes are not recognized nationwide.
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Why Is Medical Coding Helpful And Issues Of Inaccurate Coding?

nMedical Codes are a common language between payers and medical providers and are used for communication for billing. The financial importance present in the case of medical billing a provider has to be accurate in entering codes for the given medical treatment. nnWhy inaccurate codes are bad:n


  • One case of inaccurate codes is “Up-coding”. This is when a code is recorded for a higher level of service, however, the service provided to the patient was not as high. This makes Up-coding a serious offense and entering accurate codes is crucial. 
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  • Vice versa, “Down-coding” is entered at a lower level of cost than what was provided to the patient. Down-coding is often not done on purpose, instead, it requires both the provider and the coders to be trained and educated on the losses the firm may face if down-coding takes place.
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3 Billing Codes To Keep A Look Out For


Telephone Services (99441-99443)

nDue to doctors being busy these days, especially since the emergence of the COVID-19 pandemic, patients skipping the line and calling to speak to the doctor is not rare anymore. CPT codes include codes specifically for telephone services provided by physicians and other healthcare providers. nnUsed for reporting E/M services provided over the phone, telephone codes can only be used for regular patients, not for patients who come in for a face-to-face visit within 24 hours. Time is a crucial factor, as codes are different for different durations.n

Emergency (99058)

nPatients needing an emergency visit are coded “99058”. This code is used if a patient demands and needs immediate attention from the medical provider, which will as a result, cause disruption in the schedule of other appointments. This code can only be used for in-office visits.n

Health Assessment (96160)

nCode 96160 is used to provide a health risk assessment on a patient, with or without a guardian. It is used when assessing risk diseases and disorders, like those pointing to mental health.n

Outsource To Med-Miles LLC

nMedical Coding is a very complicated procedure that requires you to stay up-to-date on the latest coding updates in order to avoid errors and omissions and to generate a lot of revenue for your practice.nnIt’s a tedious task that takes up too much of your time and distracts you from your dream goal. To get yourself out of these burdensome tasks, there are Medical Billing Companies that can help you by providing Medical Billing Services Like Med-miles LLC.nnSo if you hand over these tasks to our team of experts who can handle the Medical Coding operations appropriately that would be a bigger step towards success.nnSave Your Time Today! Call us at (888) 598-9181 for Medical Coding Services.

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