Medical Coding Examples

Medical coding examples include numeric or alphanumeric codes based on classification systems used to identify medical diagnoses, procedures, equipment and other healthcare services. Medical coding is an important step in the medical billing process that dissects a patient’s chart into individual billable units for reimbursement from health insurance companies and government agencies.

Medical coding includes the following systems that are used in the United States: Current Procedural Terminology (CPT), Healthcare Common Procedure Coding System (HCPCS Level II) and the International Classification of Diseases-10 (ICD-10).

Medical Coding Examples

Medical diagnostic codes help medical coders and billers assign the correct classification codes to the corresponding patient experiences.

The process is complex and can be confusing without appropriate training. Accuracy and attention to detail are key to a medical coder’s job. Using incorrect codes can result in a delay or denial of reimbursement to hospitals and other providers. Inaccuracy can require lost time on claim resubmissions. Mistakes also can affect the accuracy of a patient’s medical record and affect future care.

Medical coders extract patient information from physicians’ notes, laboratory results and radiology reports. Their education typically includes extensive study of anatomy and medical procedures so that they can determine the correct code from the medical information provided. The codes are used to prepare a claim for reimbursement from an insurance carrier. If you’re thinking about pursuing a career as a medical coder, here are some medical coding examples to demonstrate the type of work that medical coders and billers do:

ICD-10

ICD-10 is the 10th revision of ICD. ICD-10 codes generally deal with patient diagnoses. To view medical coding examples of ICD-10 you could search through the listing of alphanumeric codes used for diseases, related health problems, abnormal findings, symptoms, external causes of injury and social circumstances. ICD-10 is used to monitor and record health conditions, classify treatments for reimbursement and track public health statistics regarding morbidity and mortality around the world.

ICD-10 codes are very specific. To start, a coder must read and interpret the description of a patient event then match it to an appropriate ICD-10 code that represents specific details of the diagnosis. Medical coding examples of an ICD-10 code typically have seven digits, though some may not be necessary. Each digit represents a specific detail about the diagnosis. The seventh digit qualifier captures details about the episode of care when necessary. An ICD-10 code also uses a decimal after the first three digits. Here is an example of a ICD-10 code for a left upper arm excision:

Meaning: This Diagnosis: Code for This Diagnosis:
Section Medical and Surgical 0
Body System Skin and Breast H
Root Operation Excision B.
Body Part Skin, Left Upper Arm C
Approach External X
Device No Device Z
Qualifier No Qualifier Z

(A decimal is inserted after the third digit.)

ICD-10 Example shown from University of Mississippi Medical Center.

CPT

CPT codes are considered the U.S. standard for documenting and reporting patient procedures. These include interactions that involve medical, surgical, laboratory, radiology, anesthesiology, and diagnostic services performed by medical professionals. All U.S. providers, facilities and payers use five character CPT codes. CPT codes are developed and maintained by the American Medical Association (AMA).

As with other medical coding examples, CPT codes require extensive detail. Medical coding examples of CPT include three categories:

  • Category I codes include five-digit codes ranging between 00100 and 99499. Each corresponds to a specific procedure or service. Medical coding examples of CPT would differentiate between CPT code 74160 which represents a CT of an upper abdomen with dye versus CPT code 74150 which represents a CT of an upper abdomen without dye.
  • Category II includes optional alphanumeric tracking codes for execution or time measurement.
  • Category III codes are used for data collection and assessment of new services and procedures.

HCPCS Level II

HCPCS Level II is made up of five character, alphanumeric codes that correspond to medical supplies, durable medical goods, nonphysician services, and services not represented in CPT. It is used for prosthetics, orthotics, outpatient hospital care, chemotherapy drugs, Medicare, and Medicaid. Blue Cross Blue Shield Association and the American Dental Association post their procedure codes as part of HCPCS Level II system.

HCPCS codes carry the same level of specificity as other medical coding examples. Their purpose is to identify the unique patient encounter with as much detail as possible to ensure proper reimbursement. For example, the HCPCS Level II code for an adhesive bandage is A6413 versus the code for an adhesive disc or foam pad, which is A5126.

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