The healthcare industry uses codes for uniformity. Two of the most highly recognized code systems are the International Classification of Disease (ICD) and the Current Procedural Terminology (CPT).
In this article, we discuss the meaning and differences between the ICD and CPT codes and their role in streamlining billing in NEMT services.
ICD vs. CPT Coding
What is ICD coding?
The World Health Organization (WHO) defines ICD as a set of codes used as the “main basis for health recording and statistics on disease in primary, secondary, and tertiary care, as well as on cause of death certificates.” It has many uses, but it is mainly intended for uniform coding for data and statistics.
These codes are also used to simplify billing and payments, diagnosis reporting, administration of quality and safety, service planning, and health or medical research.
ICD has been used for over a century and is regularly updated to reflect new codes. The latest version is ICD 11, which became effective in 2022.
What is CPT coding?
CPT works similarly to ICD, in that it is meant to standardize language in the healthcare industry. It provides uniformity to streamline the reporting of medical services for accuracy and efficiency.
The terminology is vital in administrative work, processing of insurance claims, and medical reviews. While the WHO manages ICD coding, CPT coding is under the American Medical Association (AMA).
Although created by an American organization, CPT is recognized internationally for facilities reporting on various medical issues and programs.
What is the Difference Between ICD and CPT Coding?
ICD codes are made up of alphanumeric characters. Each character means something vital to the disease. The more characters there are, the more specific it becomes.
The first letter indicates the type of disease. For example, type 2 diabetes mellitus has the code E11.9.
All letters of the alphabet have a disease or injury representation in the ICD. Here are the first five:
A and B - infectious and parasitic diseases
C - cancer
D - neoplasms, blood, and blood-forming organs
E - endocrine, nutritional, or metabolic
Meanwhile, CPT is represented by categories I, II, and III, followed by the codes. Category I is accompanied by purely numeric codes, while Categories II and III have five-character codes consisting of four numeric and a lone letter at the end.
Efficiency in Documentation: Unveiling the Role of ICD and CPT Codes
Documentation is vital in healthcare because the whole process involves different professionals and various divisions. For better medical service, all documentation must be clear and accurate, and that’s why medical coding is very important.
Because of the consistency in language and terminology, diagnosis is more accurate, and so is treatment. The correct use of codes can significantly improve patient care.
Improved Billing Process
All codes in healthcare are standardized. When integrated into documentation, the processing becomes faster and more efficient. Waiting time will be shortened and claims and refunds will be completed immediately.
Using ICD and CPT codes also ensures facilities comply with the Health Insurance Portability and Accountability Act (HIPAA) of 1996.
Integrating ICD and CPT Codes in NEMT Operations
Can you integrate ICD and CPT in NEMT?
Non-emergency medical transportation (NEMT) is an integral element of healthcare. People who need medical care but are not in emergency situations can book the service to transport them to their healthcare appointments.
NEMT is often covered by insurance, which is why providers must document their services accurately for billing. With ICD and CPT coding, companies can streamline the documentation process.
It also helps that most NEMT companies use software for their daily operations because of its many benefits:
It optimizes routes.
It provides efficient dispatching with real-time changes.
Billing is faster and more accurate.
All steps in the process work out smoothly, especially when complemented with efficient software like BillPro.
How ICD and CPT Codes Collaborate to Streamline NEMT Billing
NEMT companies need money to operate and provide efficient service to their clientele. While some are private paying customers, many are covered by insurance. Therefore, insurance refunds are crucial in NEMT service.
Manually processing claims would take a long time. There is a matter of preparing documentation and sending it out via post. But with NEMT and billing software, everything is done on a digital platform.
ICD and CPT codes will make processing even faster because they are recognized by all healthcare entities.
More importantly, they are accurate. ICD and CPT codes eliminate or reduce errors that could derail or delay claims and refunds. Plus, if there are errors, the software could easily detect them.
A simple error could lead to a denial. And while you can appeal a denied claim, the process is quite taxing, which is why some people or institutions do not bother to pursue it.
Insurance claim denials are on the rise, and some of them have been dubbed nonsensical. Still, any denial will take a lot of time to rectify. It is best to avoid it at all costs—efficient billing services should help improve reimbursements.
Efficient billing software like BillPro is also cost-efficient for NEMT businesses because all processing is much faster. The faster the claim is submitted, the faster the refund.
ICD and CPT in NEMT help streamline NEMT service and billing. The codes are standard nomenclature in healthcare, so they are easily recognized and processed. They will help NEMT businesses maintain their budgets to provide better service to their clientele. They also help with accurate billing and claims.