A Patients Guide To Learning Medical Codes

By Alley Benton
Updated January 2, 2017
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A Patients Guide To Learning Medical CodesMedical codes are important codes that are used to describe treatments and diagnoses, as well as reimbursements and costs, and how drugs and diseases relate to each other. While these codes are primarily of importance to medical professionals, you may also want to find a patient's guide to medical codes. This can help you to find out what your diagnosis is, what your health care providers do for you, how much they were paid, and to make sure that the billing is correct.

Here Is A Patient's Guide to Medical Codes:

It would be impossible to list all the codes that exist. However, knowing about the various code classifications as part of a patient's guide to medical codes is very beneficial. As such:

1. CPT (Current Procedural Terminology) codes were created by the AMA (American Medical Association) and tell you what services may be provided to you. These list services that are provided and submit these to Medicare or other insurance companies so that payments can be made. You may want to look at these codes to understand what services you received, and whether the correct payments were made.

2. HCPCS (Healthcare Common Procedures Coding System) codes are used solely by Medicare, who base them on CPT codes. If you use Medicare, and particularly for ambulance service or other services outside of the office of your physician, then these are relevant to you.

3. ICD (International Classification of Diseases) codes, which are maintained by the CDC (Centers for Disease Control and Prevention) in this country, and by the WHO (World Health Organization) globally, help to describe a condition's diagnosis. ICD codes often change, so they always have a number associated to them to show which set of codes were used. The most up to date set is the ICD-10. These codes are maintained in patient records and hospital certificates.

4. ICF (International Classification of Functionality, Disability and Health) codes, which are new codes used to determine the functionality of patients in their environment. They are maintained in this country by the CDC.

5. DGRs (Diagnosis Related Groups), which were created by Medicare to help classify hospital services by type of treatment, diagnosis, and more in order to bill a patient properly. For patients who are admitted to a hospital, the DGR determines what their reimbursement will be, regardless of what the actual cost was, or what Medicare is billed for. Some 500 DGRs currently exist, and new ones are added if new conditions (like H1N1) are uncovered.

6. NDCs (National Drug Codes), which are listed in the National Drug Code Directory, which has been maintained by the FDA (Food and Drug Administration) since 1972. These are three segment figures that identify products. The list is found on the FDA website. Having an NDC does not mean a drug has FDA approval.

7. CDT (Code on Dental Procedures and Nomenclature) codes, which are developed specifically for dentists.

8. DSM-IV-TR (Diagnostic and Statistical Manual of Medical Disorders, 4th Edition, Text Revision) codes, which are used for the diagnosis of psychiatric illnesses, and is maintained and published by the APA (American Psychiatric Association).

* Disclaimer:
This site offers information designed for educational purposes only. You should not rely on any information on this site as a substitute for professional medical advice, diagnosis, treatment, or as a substitute for, professional counseling care, advice, diagnosis, or treatment. If you have any concerns or questions about your health, you should always consult with a physician or other health-care professional.