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    Diagnostic and Procedural billing

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    Lisa is a new medical assistant at the local family practice physician office. She is nervous about her first job in health care and really wants to learn all that she can. During her training, the other employees teach her about coding for processing claims. She is a bit confused by the difference between diagnostic and procedural coding. What are the differences between diagnostic and procedural coding, what is the name of the major coding system for each, and why is it important to use the correct codes when processing claims?

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    The medical claims have been standardized to facilitate processing and payment. This makes it easy for everyone to read, understand and process them accordingly. For billing purposes, the diagnosis code describe the disease(s) or complain(s) for which the patient was seen by the health care provider. In able to make it easy for everyone to understand and avoid misunderstanding, the World Health Organization (WHO) devised a system of numbers (or code) and assigned a number to each diagnosis. Today the system of numbers is called ICD-10. ICD stands for international classification of diseases and 10 for the 10th revision. (Some people may refer to them as ICD-9 code which was the previous version of the coding for the past 30 years.) It is expected that by 2015 there will be a new revision called ICD-11. The diagnosis code should always match the procedure code.

    The procedure code describes the procedure, task or service that the health care ...

    Solution Summary

    The differences between diagnostic (ICD-10) and procedural (CPT) codes are discussed with examples explaining the importance of their correct use in billing.