What is the difference between ICD-10-CM and CPT codes in medical billing and coding?

 Difference between ICD-10-CM and CPT codes

In medical billing and coding, ICD-10-CM and CPT codes serve different purposes and are used in distinct aspects of the healthcare documentation process. Here’s a breakdown of their differences:

ICD-10-CM (International Classification of Diseases, 10th Revision, Clinical Modification)

1. Purpose:

   - Diagnosis Coding: ICD-10-CM codes are used to describe the diagnosis or condition of the patient. They capture the reason for the visit or the medical condition being treated.

2. Structure:

   - Code Format: Codes are alphanumeric and can be up to 7 characters long. They start with a letter followed by numbers and additional letters or numbers.

   - Example: E11.9 (Type 2 diabetes mellitus without complications)

3. Usage:

   - Medical Records: Used in patient records to document diagnoses.

   - Insurance Claims: Required for insurance claims to indicate the medical condition that justifies the services provided.

4. Updates:

   - Revisions: ICD codes are updated periodically to reflect changes in medical knowledge and practice.

CPT (Current Procedural Terminology) Codes

1. Purpose:

   - Procedure and Service Coding: CPT codes are used to describe the medical procedures, services, and treatments provided to the patient. They capture what was done during the visit.

2. Structure:

   - Code Format: Codes are numeric and typically 5 digits long.

   - Example: 99213 (Established patient office or another outpatient visit, 15-29 minutes)

3. Usage:

   - Billing: Used for billing and reimbursement purposes to specify the services and procedures performed.

   - Medical Records: Helps in detailing the specific interventions or treatments provided during a patient encounter.

4. Updates:

   - Annual Updates: CPT codes are updated annually to include new procedures and reflect changes in medical practice.

Summary

- ICD-10-CM codes are used for diagnosing and coding the patient's conditions.

- CPT codes are used for documenting and billing the procedures and services provided to the patient.

Both coding systems are crucial in the medical billing process, with ICD-10-CM providing the diagnosis and CPT codes detailing the treatment or service performed.