CPT

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ICD-10 is coming…ICD-10 is coming

December 7, 2011 in Data | 1 comment

Many health insurers (public and private) reimburse doctors based on the patient’s diagnosis. If you treat a patient for a more severe illness during a inpatient stay, Medicare pays you more money. Physicians use procedures to bill insurers for the care they provided.

How do insurers know the patient’s diagnosis and the procedures providers perform? The answer is the International Classification of Disease (ICD) taxonomy. Currently, this system is in its ninth iteration, but it will soon be replaced by ICD-10 (the tenth revision) codes. By January 1, 2012, CMS will mandate that all electronic health record transaction use the ICD-10 system and by October 1, 2013 providers will all have to use the ICD-10 diagnosis and procedure codes for their claim submissions.

What’s new about the ICD-10 compared to the ICD-9? Read more below to find out.

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Does Medicare use CPT codes for payment?

July 13, 2010 in Medicaid/Medicare, Part B | 2 comments

For Part B services, Medicare pays physicians based on the services they provide.  The American Medical Association (AMA) developed Current Procedural Terminology (CPT) codes to create a taxonomy of procedures that physicians perform.  Does the Centers for Medicare and Medicaid Services (CMS) use these codes for payment?

The answer is yes and no.  Officially, CMS uses Healthcare Common Procedure Coding System (HCPCS) codes.  These codes are used to classify about 6,700 distinct services. Although CMS does not officially use CPT codes, the HCPCS are closely related to CPT codes.  In fact, there are two sets of HCPCS codes. “The first set, HCPCS Level I, are based on and identical to CPT codes…Level II HCPCS codes are used by medical suppliers other than physicians, such as ambulance services or durable medical equipment.”

The Medicare Administrative Contractor (MAC) actually process the payment for these claims.  There are 4 MACs for durable medical equipment claims and 15 MACs for processing Part A and B claims.

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