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ICD and CPT Codes
ICD and CPT codes are both used in medical billing and coding, but they serve different purposes. ICD codes are used to describe the diagnosis or reason for the medical service, while CPT codes are used to describe the actual medical service or procedure provided.
ICD codes (International Classification of Diseases) are a standardized system of codes used to classify and code diagnoses and medical conditions (Hong & Zeng, 2023). These codes are used to describe the medical condition or disease being treated or diagnosed. ICD codes are typically used by healthcare providers and insurers for billing purposes, but they are also used for public health surveillance, research, and clinical decision-making.
CPT codes (Current Procedural Terminology) are a standardized system of codes used to describe medical services and procedures provided by healthcare providers (Joo et al., 2021). These codes are used to report the specific services and procedures that were provided to the patient. CPT codes are typically used by healthcare providers and insurers for billing purposes.
Evaluation and Management (E/M) Guidelines are a set of rules and documentation requirements used to determine the appropriate level of service for a patient encounter. These guidelines help ensure that healthcare providers are accurately and consistently documenting patient visits and are properly billing for the services provided.
The E/M Guidelines are divided into two main components: history and examination, and medical decision-making. The history and examination component evaluates the level of detail and complexity of the patient's medical history and physical examination. The medical decision-making component evaluates the complexity of the medical decision-making process required to diagnose and treat the patient.
In conclusion, ICD codes are used to describe the diagnosis or reason for the medical service, while CPT codes are used to describe the actual medical service or procedure provided. The Evaluation and Management Guidelines help ensure that healthcare providers are accurately and consistently documenting patient visits and are properly billing for the services provided.
References
Hong, Y., & Zeng, M. L. (2023). International classification of diseases (ICD).Ko Knowledge
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Joo, H., Burns, M., Kalidaikurichi Lakshmanan, S. S., Hu, Y., & Vydiswaran, V. V. (2021).
Neural machine translationbased automated current procedural terminology classification system using procedure text: Development and validation study.JMIR formative research,5(5), e22461.
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