Tools of the Medical Billing

1.CPT Book – Procedural Coding

Medical services provided by physicians are identified using the AMA Current Procedure Terminology or CPT codes. The AMA CPT book provides descriptors for each of the 8,000 codes listed. Frequently there are additional instructions for code use in each section of the book. These CPT rules should be followed when choosing the correct code to describe the service provided

2.ICD-9-CM - Medical Diagnosis Coding

The ICD-9-CM coding system contains three "volumes" of coding information although the volumes come in one book. Volume 1 contains the diagnosis codes that every provider needs for billing. Volume 2 is an alphabetical index of Volume 1. Outpatient diagnostic or treatment centers, like physician offices, need only Volumes 1 and 2. Thus, books that contain only Volumes 1 and 2 are often referred to as physician, office, or outpatient editions.

Volume 3 contains procedure codes, not diagnosis codes. Volume 3 codes are used for billing inpatient hospital stays in the DRG system so books that contain Volume 3 are called hospital, payer, or inpatient editions

3.HCPCS – CPT Level II codes

HCPCS Level II codes are used to bill Medicare for supplies, materials, injections, DME, rehab, and other services.

4.NCCI Manual

National Correct Coding Initiative guide will help us code our service for reimbursement in compliance with CMS’s policies to prevent claim rejection, delays, and audits.