ICD-10 vs. CPT Code Technology

Medical providers have a lot to handle. And errors in coding for doctors, physicians, nurses, and other healthcare providers only complicate the process. In recent years, outsourced medical coding solutions have saved healthcare organizations time and money.

Continue reading to learn about the differences between ICD and CPT code technology providers like Horizon Healthcare use for daily operations and revenue cycle management.

What Is ICD-10 Code Technology?

ICD-10 (International Classification of Diseases, Tenth Revision, Clinical Modification) is a common type of coding used by medical providers for operational information management. The ICD-10 code definition is a system used by healthcare providers and physicians to code and classify all diagnoses, procedures, and symptoms recorded within medical care in the United States of America.

ICD-10 coding technology is based on guidelines from the International Classification of Diseases, annually published by the World Health Organization.

The Importance of ICD-10 Codes

ICD-10 code technology benefits both patients and healthcare workers by providing the most accurate information regarding a patient’s condition and the severity of the situation. ICD-10 technology has been upgraded from previous versions because code capacity failed to expand. With an ever-growing medical field, current practices require up-to-date technology by the minute.

What Are ICD-10 Codes Used For?

The World Health Organization bases its practices on numeric codes to identify diseases and other health-related problems. Nurses, physicians, health information managers, coders, and other healthcare workers across the country rely on ICD-10 technology to assist in diagnostic and storing of information. Increased capabilities of the current version of ICD technology compile national health statistics.

Every Health Insurance Portability and Accountability Act-covered provider (HIPAA) is mandated to use ICD-10 technology with the guidelines of the U.S. Department of Health and Human Services organization (HHS).

Types of ICD-10 Codes

Every type of ICD-10 code consists of three to seven characters. Each code begins with an alpha character followed by two numerical characters. The coding strand concludes with four characters that can be either numbers or letters. Listed below are examples of different ICD-10 codes for their intended classification:

G10: Huntington’s Disease
K26.1: Acute Duodenal Ulcer, Perforation
A37.81: Whooping Cough, Pneumonia
125.111: Atherosclerotic Heart Disease, Angina Pectoris
M80.021G: Osteoporosis, Pathological Fractures

What Is CPT Code Technology?

You may have noticed every procedure within a medical facility comes with paperwork. You don’t know that every check-up, lab test, surgery, or scan has a code attached. Current Procedural Terminology (CPT) coding technology is typically a five-digit numeric code assigned to each task and service of healthcare providers across the United States.

The Importance of CPT Codes

CPT coding technology is used to bill and track every medical, diagnostic, and surgical procedure provided by healthcare organizations. Medical insurers then need CPT codes to determine bill payments to providers.

What Are CPT Codes Used For?

CPT coding technology offers doctors, physicians, nurses, and all other healthcare workers a concrete language for coding medical procedures and services with precise accuracy and efficiency. Coding also directly determines how much a patient pays for the services they have received from a healthcare provider.

Types of CPT Codes

Reviewed and regulated by the Health Insurance Portability and Accountability Act (HIPAA), nationwide algorithms set for healthcare professionals are utilized in CPT coding for a full range of accurate medical services. Each CPT code consists of a five-digit numeric or alphanumeric version.

Wide ranges of coding benefit all parties, and are focused on a common set of standards so diverse users have an overall understanding across the healthcare spectrum. Listed below are the various types of CPT codes:

Category I: The first level of CPT coding has descriptors corresponding to a specific procedure or service. Codes range from 00100 to 99499.
Category II: The second level of CPT coding is utilized for performance measurement. Alphanumeric codes are supplemental and not required for the coding process.
Category III: The third level of CPT coding uses alphanumeric labeling for medical providers developing new technology, procedures, and services. The primary focus for Category III CPT codes is data collection and assessment.
Proprietary Laboratory Analyses Codes (PLA): These are recently developed codes provided by laboratories and are cleared in association with organizations like the Food and Drug Administration (FDA).

ICD-10 vs. CPT technology is a hot debate among medical providers. Whichever route your medical organization prefers, Horizon works to provide quality results with both coding systems. Learn more about outsourced medical coding solutions today.

Medical Coding Services

ICD-10 Coding Applications

ICD-10 technology is categorized into sections based on its intended application. Outlined below are a couple of examples of ICD-10 sections and their use:

Medical and Surgical Sections

Medical and surgical codes are all used solely in the United States for this practice in hospital settings.

Ancillary Sections

Ancillary coding is covered across various sections for uses like nuclear medicine, substance-abuse treatment, and image monitoring.

CPT Coding Applications

Outsourced providers begin the coding process using an electronic health record. Staff members onsite can then bring up codes based on the service name. Listed below are a few CPT applications throughout the coding process:

Claim Processing

Health plans use CPT codes to process claims. CPT codes determine the price of service and how much providers are owed.

Research

Health insurance companies rely on CPT codes to predict future estimated costs of medical services.

Discharge Paperwork

Patients are provided with documentation once they are discharged from a medical facility. All services and procedures provided are documented in a database through CPT codes.

Man Showing Coworker Invoice for Medical Billing

Outsourced Medical Coding Services

Receiving coding from a third party allows medical organizations to put more time and effort into their primary operations. Outsourced coding specialists provide:

Flexibility to focus on patient care
Updated coding technology for accurate assurance and revenue accounting
Thorough coding processes directly aligned with goals and requirements

Reputable healthcare companies like Horizon offer audit and medical necessity review services:

Audit

Strategic auditing makes the reimbursement process easy for healthcare providers. Well-implemented audits help correct incomplete documentation, outdated coding, and processing errors.

Medical Necessity Review

Healthcare providers avoid claim denials by utilizing outsourced medical necessity review with quality coding procedures, proper documentation, and evidence-based review.

Horizon Healthcare: An Industry-Leading Coding Specialist of ICD-10 and CPT Technology

At Horizon Healthcare, we know how challenging it can be to address coding errors in the fast-paced medical industry. Our internal team of coders works efficiently to make sure your workplace is organized and up to date while your staff is busy delivering an excellent patient experience. Horizon’s certified coders are highly qualified, trained, and exemplary at identifying coding errors in any medical system. Contact our team of experts for a convenient, more efficient future today.