Question

Explain how CPT codes are different from ICD codes. (with reference)

Answer 1

Ans) The CPT code describes what was done to the patient during the consultation, including diagnostic, laboratory, radiology, and surgical procedures while the ICD code identifies a diagnosis and describes a disease or medical condition.

- The CPT codes are used to report various medical procedure and services taken into account by the physician during their treatment period. The services can range from anything related to mere diagnosis, to surgery, laboratory tests or radiology. Each code is described in the CPT book and deciphers the procedure followed by the doctor during the consultation. Simply put, it outlines what exactly was done to the patient while consulting. It also describes the medical services done by the doctor. A CPT code acts as a communication bridge between the patients, physician and the insurance companies, and provides a uniform format to describe the diagnostic and treatments procedures performed on the patient. CPT codes are then used by the insurance companies to decide the fee for physician’s services. AMA, the ‘American Medical Association’ maintains and holds all the copyrights for this ‘U.S. standard coding and billing’ medical procedure.

- The ICD codes are used to describe a disease and identify the diagnosis of a particular medical condition.Once the physician identifies the problem, a diagnosis code is assigned to the patient, which can be found in the ICD code books; ICD-9 or ICD-10. It aims towards describing the exact problem or disease that a patient is suffering with, so that the patient, physician as well as the insurance provider can better comprehend the medical condition under treatment.The ICD codes are recognized and accepted internationally. It was developed by the ‘World Health organization’- (WHO), who is also responsible for monitoring,maintenance and holds all of its copyrights. The ICD codes are written in the form of alphanumeric characters that can be applied to any symptom, diagnosis and cause of death. Since these alphanumeric codes follow an international standard, they can be recognized easily by any physician, patient and medical insurance provider whether in U.S. or in any other country. The ICD-9 version of these alphanumeric codes is currently used in United States; however, more physicians and insurance organizations are now replacing it with the ICD-10 version. ICD-10 is more complex and longer than the ICD-9 version and describes the codes more comprehensively. The appearance of symptoms is also recorded, for example, which symptom appeared first and on which side. It also eliminates the risk of running-out of possible codes for diseases and diagnosis.
CPT ranks higher than ICD in terms of complexity. For instance, any particular disease or medical condition will have only one ICD code. However, in order to describe it in CPT code, you would have to determine the situation of the patient, when he/she visits the doctor for consultation. The total time spent for consultation and diagnosis and even the number of vital systems examined by the physician, makes the process of assigning a code rather complex.