What Is A Medical CPT Code

Since it first appeared in seventeenth century London, early forms of medical coding dealt primarily with mortality and everything associated with it: diseases, death rates, and recognized symptoms of diseases or ailments. Considering that codifying medical conditions arose from the era of bubonic plague in Europe, it is easy to see why early “coders” were so preoccupied with death and all its causes.

It was not until four hundred years later that medical coding fully advanced into its current form. The 1960s marked the birth of CPT codes, which stands for “Current Procedural Terminology.” These codes were developed and presented by the American Medical Association (AMA) to represent medical services.

These codes contain five digits and describe a variety of medical attention forms. For instance there is a code for everything ranging from routine check-ups to vaccinations. The comprehensive set of codes is released and regularly amended by the AMA to ensure that it retains its accuracy and effectiveness, regularly re-releasing the official publication.

CPT codes are critical to any medical facility in the United States. Without CPT codes, a medical coder and biller would be unable to accurately bill an insurer or patient. A coder must have access to accurate and thorough codes describing medical conditions and treatment. Linking the diagnosis code to the code of the treatment rendered makes billing a high-efficiency machine, cutting payment delays and securing customer satisfaction.

CPT codes are not accessible to the general public for free because the AMA publishes these codes itself and therefore exercises considerable control over their release. Medical coders or those aspiring to break into the field, however, can purchase code books and corresponding computer software through the Internet or programs from the AAPC (American Academy of Professional Coders) or AHIMA (American Health Information Management Association).

What Are The ICD-9-CM Codes Used For?

As you are likely to already know, the medical industry operates on a series of codes to describe diagnoses and treatments. Just like mathematics, medicine operates as a universal system.

A patient seeing a doctor in Tennessee for chronic coughing and chest pain can be referred to someone in Nebraska with a code to follow – a number that conveys the exact problem to another doctor miles and customs away.

ICD-9-CM codes are a specific type of medical coding, and you first have to break down the name structure to understand what they’re for:

1. First of all, “ICD” stands for “International Classification of Diseases.” ICD is a publishes system of disease coding for all known diseases and factors proven to result in fatalities.
2. The number 9 refers to the revision; thus, “ICD-9” indicates that it is the ninth revision of the publication. New revisions come out when significant enough changes have been made to necessitate an entirely separate publication.
3. “CM” stands for “Clinical Modification,” which indicates that diagnosis and treatment codes have been added to the coded afflictions/circumstances of death. ICD codes only cover causes of death, whereas ICD-CM also includes treatments.

Medical coders use ICD-9-CM codes when billing insurance companies or other payers of a medical service. These codes describe everything from the medical problem that brought the patient to the hospital to the treatment’s results. 


Matching the diagnosis and treatment codes also keeps a thorough file of a hospital or practice’s activity. If the office’s integrity comes into question, a medical coder can refer back to the file with ninth revision code books in hand to make sure the file is straight.

Because this is the ninth revision in a constantly revised publication, soon its codes will be discontinued. However, until October 2013, it will continue to be used to record medical diagnoses and treatments as well as bill insurance companies and payers.

You may have further questions on revisions. If so see this post on using prior year's medical coding books.

What’s The Difference Between The CPC And The CPC-P Coding Certifications

Based from the latest information, American Academy of Professional Coders or the AAPC has already certified about 70,000 professionals under the health information management field. In addition to this, there are different coding certifications available nowadays such as CPC and CPC-P. Perhaps, you want to know the difference between these two certifications.

When you encountered CPC or Certified Professional Coder certification, this gives opportunity for professionals to work in office setting. Moreover, having this kind of certification means that you have sound knowledge when it comes to languages like HCPCS Level Ii and CPT. In addition to that, this certification indicates that you also have knowledge about ICD-9-CM diagnosis codes.

On the other hand, Certified Professional Coder - Payer or the CPC-P certification means that you have expertise in reimbursement methodologies applicable in great medical coverage and settings. In addition to that, this also indicates that you have skills needed in reviewing payment systems and other related matters. Examples of these are HIPAA compliance regulations and rules as well as health insurance concepts.

These are some of the differences between CPC and CPC-P coding certifications. Though there are differences when it comes to these certifications, both play a very important role in terms of making information relay in a department a lot efficient and organized. As mentioned, there are also other certifications that you can find out there such as the CPC-A or apprenticeship designation or the more advanced CPC-H designation.

Additionally there are many specialty certifications that you can attain which focus in on different fields in medicine. These special certifications give you more appeal to employers dealing with certain types of medical scenarios versus the whole gambit. This post covers many of the popular subspecialty coder certifications you can get to stack on top of your CPC or CPC-P credential.

It is best for you to learn more information about those certifications by means of conducting your own research and even asking questions from people currently employed in these fields.

The Standard Medical Coding And Billing Job Description

A basic job description for medical coders (and many billers too) is as follows:

A coder is responsible for codifying diagnostic and treatment terms and keeping record of these codes so that patients or their insurers may be accurately billed for services received. The worker is required to demonstrate heavy background knowledge in human anatomy and physiology, as well as “etiology, pathology, symptoms, signs, diagnostic studies, treatment modalities, and prognosis of diseases and procedures,“ as described by the AHIMA (American Health Information Management Association). The worker must work well with practitioners and patients, acting as the middle link in the billing process.

In short a coder translates the medical treatment and diagnosis from physicians and care givers into alpha-numeric codes which are typically used for billing, records keeping, and reference/statistical purposes.

The details that are usually controlled and stored within a data set consist of health history, diagnosis, treatment procedures and symptoms. Coding is utilized as a way in order to allow both physicians and provider of health care to get hold of fees for their rendered services. The codes allotted help to set up the total money a health care provider can refund from a lot of insurance companies.

In addition to this, the job of a medical coder needs the utilization of several coding numbers intended for ambulatory settings, billing purposes, and longer time health care. With this, it is important for a medical coder to keep the appropriate credentials given by the CSA (Coding Special Authorities) or the ART (Accredited Record Technician).

Holding a CPC credential from the AAPC is one of the best ways to demonstrate that you know what you are doing as a medical coder and that you can perform your job well.

A medical coding technician keeps an associate’s degree when it comes to health information knowledge in order to be part of the field. Moreover, gaining properly clinical understanding on physiology, disease process, pharmacology and anatomy could be an extra advantage to have right translations of the medical terminologies into applicable codes.

Coding systems that are included in the documentation prerequisites consist of ICPM, ICD9-CM, HCPCS/CPT and DSM-IV. The utilization of these codes, which is basically covered in the job description of a medical coder will assure that the diagnosis and operative procedures advised by a doctor is qualified.

A job description to cover all bases in the industry should also require that the coder must meet a duty to ensure that these codes complete every standard insurance, legal and federal rule for quicker service payments.

Medical coders can make pretty good money as one might surmise by the complexity of the job description itself. If you are interested in becoming a medical coder see this post on jumpstarting your medical coding career quickly.

What’s The Difference Between A CPC And A CPC-H Credential?

In the medical coding and billing world there are tiers of certifications. All certifications are optional for professionals however the AAPC certification credentials are quickly becoming mandatory for almost all medical coders who wish to make a good living.

It is widely known that medical coders make more money when they have years of on the job experience and also when they processes specialty training and CPC certification. The AAPC however certifies professional coders in various specialties in addition to the standard CPC credential.

The CPC-H credential is the Certified Professional Coder (Hospitals-Outpatient) whereas the regular CPC is for general physician practices. Both credentials require substantial knowledge of the CPT, ICD-9, and HCPCS Level II codes but the CPC-H credential builds upon the CPC credential testing the professional coders knowledge in hospital settings more substantially.

To get the CPC-H credential typically means you as a professional coder are worth more. You command a higher salary and you demonstrate experience in your field. For one it takes more knowledge to pass the CPC-H exam but also because you can’t even take the exam unless you have two years of experience as a CPC or a CPC-A (otherwise known as a CPC apprentice).

Other than the requirement to be a certified CPC for two years prior to CPC-H testing there isn’t any further requirements to take the exam. Just like the CPC exam you have to be a member of the AAPC and have to pay the exam fees to take the CPC-H exam.

Also similar to the CPC certification a coder who passes the CPC-H exam must continually remain a AAPC member and satisfy the continuing education units (CEU) to maintain CPC-H credentials.

What Is Medical Coding?

When you go to the doctor or hospital and you are diagnosed with some sort of disease or condition or some sort of procedure is done on you a medical coder will translate that treatment or diagnosis into the universal medical code numbers so that it is understandable across all languages as well as for billing purposes.

It is easy to find doctors that will describe medical conditions in different ways every time but if the medical code number used is the same then it’s like it’s the same situation between two people.

A career in medical coding is when a person works with these medical code numbers. Most medical coders will work for billing to ensure medical procedures and visits are billed correctly. The universal medical code numbers make things uniform and consistent across all practices.