Monday, January 30, 2023

What Are The 3 Main Medical Coding Types?

Must read

What is Medical Coding & Three Main Types of Medical Coding?

Medical coding is the process of changing medical services findings, techniques, clinical benefits, and hardware into general clinical alphanumeric codes. 

The diagnoses and procedure codes are taking from clinical record documentation, like records of doctor’s notes, research facility, radiologic results, and so forth.

Medical coding experts assist with guaranteeing the codes are applied accurately during the clinical charging measure. It incorporates abstracting the data from documentation, relegating the necessary medical codes, and making a case paid by protection transporters.

Medical coding comes up each time you see a medical services supplier. The medical care supplier audits your complaints and clinical history, makes a specialist evaluation of what’s up and how to treat you, and archives your visit. That documentation isn’t just the patient’s continuous record, and it’s how the medical care supplier gets compensated.

The primary undertaking of a Medical Coder is to audit clinical statements and assign standard codes utilizing CPT, ICD-10-CM, and HCPCS Level II grouping frameworks.

A coder is an expert who will gather clinical reports from a doctor and turn that data (the state of the patient, the analysis of the specialist, the medicine, and whatever other system that the doctor performed on the patient) into a bunch of codes. These codes structure an essential piece of the clinical cases.

For better productivity, there are three main medical coding types as ICD, CPT, and  HCPCS. First, let’s see the detailed description of each medical coding type.

  1. ICD Medical Coding Type

ICD, known as the International Classification of Diseases, is the most famous and common medical coding type. ICD codes were established in the late 1940s by the World Health Organization.

As long as the initiation of ICD, it had more updates more times. ICD medical coding type makes a standard glossary that helps to describe the injury or illness.

Generally, the United States used the ICD-10-CM medical coding type and ICD-10-PCS.  ICD-10-CM is for diagnosis, and ICD-10-PCS (Procedure Coding System) is for inpatient hospital procedures.  

The meaning of ICD-10-CM is that it is the 10th revision of the ICD code, and CM means the clinical modification. Clinical Modification increase the number of codes. For example, ICD-10 has 14,000 codes, and ICD-10-CM has 68,000 codes.

ICD medical coding type describes the patient’s medical condition and shows the diagnosis given by the doctor. These codes estimate the medical essentiality throughout the medical billing process. First, medical coders have to confirm a given diagnosis accompanies the billing procedure. 

  1. CPT Medical Coding Type

CPT (Current Procedure Terminology) medical coding type monitors, known the physician’s office’s medical procedures. American Medical Association has maintained this CPT medical coding type. And also, CPT is updated and copyrighted once a year.

CPT medical coding type has three categories.

The first one covers six main medical fields: medicine, Surgery, Evaluation, Radiology, Pathology & laboratory, and Management. It includes five-digit codes.

The second one of CPT keeps in touch with performance measurement and testing results. This code category minimizes the executive waste of the office by providing exact details. This used alphanumeric tracking codes.

The third CPT code category work with urgent medical technology and services. Category 3 of CPT codes used provisional codes.

Generally, medical coders work with the first two categories and mainly with the 1st category of CPT medical coding type.

CPT medical coding type has different qualities for increase the explicitly and correctness of codes. The American Medical Association developed some modifiers of CPT because medical practices require more features than the existing CPT medical code has.

Modified CPT codes have added two-digit codes for the end of the first CPT category. These modifiers add significant detail to the code. As an example, there is a modified CPT code for a discontinued procedure. 

  1. HCPCS Medical Coding Type

The HCPCS is known as Healthcare Common Procedure Coding System medical coding type, is closed to CPT codes. American Medical Association maintained HSPCS codes, and CMC does the updates. 

HCPCS medical coding type work with processors which are not covering by CPT codes. HSPCS does not directly use physicians’ work and medical equipment; necessary medicines, prosthetics, and ambulance services include creating HSPCS medical coding type.

HSPCS medical coding type also has two paths. CPT code identification is the first path, and medical and lab services include in the second path.

Because Medicare and Medicaid also used HSPCS medical coding type, HSPCS is the principal code used by the medical coder. An essential factor that HSPCS medical coding type is to keep in touch with the medical report.


We should begin with a straightforward inquiry concerning medical coding: Why do we code clinical reports? Wouldn’t it be sufficient to list the indications, judgments, and techniques, send them to an insurance agency, and hold back to hear which administrations will have the repayments?

To respond to that, we need to take a gander at the enormous measure of information that each persistent visit involves. Unlike that, a patient goes into the specialist with a sensitive throat and presents the specialist with indications like fever, sore throat, and expanded lymph hubs. These will record, alongside the strategies the specialist performs and the medication the specialist endorses.

In a direct case like this, the specialist will formally report his finding, yet that implies the piece of that report that will code contains a determination, a method, and a remedy.

Make a stride back, and this is abruptly a ton of quite sure data. Also, that is only for a generally straightforward specialist’s visit. What will happen when a patient comes into the specialist with a confounded physical issue or infection, similar to a visual disability identified with Type-2 diabetes? 

As wounds, conditions, and sicknesses get more perplexing, the information has passed on to insurance agencies increments altogether.

More than 1 billion patients visit medical clinics per year in conformity to the Centers for Disease Control. That detail incorporates visits to doctor workplaces, medical clinic outpatient offices, and trauma centers. 

If there were only five bits of coded data per visit, which is a ridiculously low gauge, that’d be 6 billion individual snippets of data that have moved each year. Thus, in a framework stacked with information, clinical coding considers the proficient exchange of colossal data measures.

Medical coding additionally considers uniform documentation between clinical offices. The code for streptococcal sore throat is something similar in Arkansas for what it’s worth in Hawaii. 

Having uniform information considers compelling examination and investigation, which government and wellbeing organizations use to follow wellbeing patterns significantly more proficiently. 

If the CDC, for instance, needs to investigate the pervasiveness of viral pneumonia, they can look for the quantity of ongoing pneumonia analysis by searching for the ICD-10-CM code.

At long last, medical coding permits organizations to take a gander at the pervasiveness and adequacy of treatment in their office. Medical coding is particularly imperative to huge clinical offices like medical clinics. 

Like government offices following the frequency of a specific infection, clinical offices can follow the effectiveness of their training by investigating.

Medical billing and coding experts and suppliers utilize these two orders frameworks consistently, and they are the “books of scriptures” and building blocks for this industry.

Consistently, it is mission basic for billers and coders to acquire the new forms of both these code sets to keep up to date with any progressions to principles in both of these arrangement frameworks. Or else they will chance denied cases and potential consistency issues.

What are three types of billing systems in medical care?

There are three types of billing systems named Light, Full-Service, and Boutique. In addition, many billing software dealers offer a light level of service—the whole Level of service provided by some software dealers and most regular billing services.

What are the best certifications for becoming a medical coder?

  • Certified Professional Coder (CPC) certified from the AAPC.
  • Certified Coding Specialist (CCS) certified from the AHIMA. 
  • Certified Coding Specialist – Physician-based (CCS-P).

What is the capability for medical coding?

The individual should have a four-year college education or graduate degree to seek medical coding, ideally from a life science foundation. One should likewise have the scientific capacity to peruse and investigate clinical records and patient subtleties by utilizing the correct codes for the charging method.

Is medical coding a great job?

Medical billing and coding had been among the most sought-after callings. Indeed, the Bureau of Labor Statistics recorded clinical coding among the 20 quickest developing occupations. 

AAPC noticed that “employer stability factors into personal satisfaction,” which is one motivation behind why clinical coding is a decent professional decision.

What amount do clinics pay for software?

For an in-office, self-facilitated arrangement, assessed forthright expenses are $33,000, with a $4,000 yearly cost—a cloud-based arrangement midpoint of $26,000 for direct costs with an annual fee of $8,000. Likewise, with the product framework, yearly expenses are per client.

More articles

Latest article