DOS 752 - Week 4 Discussion
Post: ICD and CPT Coding
In the process of documenting care and seeking reimbursement for services rendered, it is important to be able to refer to diagnoses and procedures unambiguously so that information is conveyed accurately to others. In order to facilitate this process, two systems of coding have come into common use. The International Classiciation of Disease (ICD) system and the Current Procedural Terminology (CPT) system are coding systems for describing diagnoses and services provided respectively.1
The ICD system has gone through several revisions since its creation more than a century ago.2 The 9th version (ICD-9) covered the years 1979-1998, and it was supposed to replaced by ICD-10, which covered the years 1999 onwards. The change was delayed and delayed in the US for years, and is only now going into effect in 2015. The new version changed the numbering scheme significantly by adding more optional digits and letters to create hyper-specific variants of codes and to allow for the creation of new codes over time. The increased specificity of coding in ICD-10 is beneficial for differentiating similar but distinct conditions and complaints that previously had to be coded identically. This is an important change because ICD codes are the basis for documenting the medical necessity of procedures performed. A vague description is nobody's friend. Since ICD can document complaints, social conditions, and symptoms as well as diagnoses, much richer information can be documented in a standardized way. In some cases, this hyperspecificity can go down almost absurd and improbable paths, which has inspired a light-heartedly mocking website that has recruited artists to illustrate some of the more obscure codes for a books, posters, and cards:3
Figure 1. Exerpt from the book Struck by Orca illustrating ICD-10 code V91.07xD.
I bought the Struck by Orca book from this site for my department and it was received with some eye rolling and more than a little amusement.
The CPT system is similar to ICD in that everything has a code, but the goal is accurately capture charges for reimbursement of services. Once medical necessity has been established by an ICD code, insurance providers will use CPT codes as a reference for how much to pay for the services that a patient consumed.
- Lenards N. Operational Issues in Radiation Oncology: Billing and Coding. [SoftChalk]. La Crosse, WI: UW-L Medical Dosimetry Program; 2011.
- International Classification of Diseases, Ninth Revision (ICD-9). Center for Disease Control and Prevention Website. http://www.cdc.gov/nchs/icd/icd9.htm. Updated September 1, 2009, Accessed November 25, 2015.
- ICD-10 Illustrated. ICD-10 Illustrated Website. http://www.icd10illustrated.com. Accessed November 25, 2015.