Medical Coding Acronyms – What Do They Mean?
Attorneys working on medical claims often use a medical billing expert to sift through a client’s medical bill or bills. It can be handy to at least know something about the coding jargon used by these experts so that communication is made a little easier. Medical coding can seem to the layperson like another language, and in some ways it is. However, like many languages, once the rudiments have been learned, it can be a window into an important aspect of medical litigation. The more effective the communication, the greater the savings and that’s generally what medical billing reviews are all about anyway!
Medical coding acronyms
These are the acronyms used in the medical billing and coding world. There is no need to know what they all are, as in the case of CPT and ICD codes at least, there are literally thousands of them. However, it helps to know at least what these acronyms mean:
- ICD 9/10
- CMS-1500 and UB-04
UCR stands for “usual, customary and reasonable.” It is used in relation to a physician’s fee. The ‘usual’ fee is what the physician normally charges for a particular service. The ‘customary’ fee is what is normally charged by physicians with similar qualifications and experience in a given geographical area for a particular service. A ‘reasonable’ fee is a fee that is charged that fits both the ‘usual’ and the ‘customary’ categories, or is in other ways considered reasonable for the specific circumstances involved.
CPT stands for ‘Current Procedural Terminology.’ It is a list of literally thousands of codes maintained by the American Medical Association (AMA) which are used to describe medical procedures, services and supplies. As can be imagined, as these are what the patient has received from the provider, the codes are what medical billers use to determine the cost of treatment. CPT codes can be normally recognized by their five numeric digits.
ICD codes are codes determined by the World Health Organization (WHO) and are used to denote specific diagnoses. The codes are internationally recognized, so theoretically, an ICD10 code given by a European medical professional will be instantly recognized by his or her American counterpart. Just to make things a little more complex is that the ICD system has been revised recently (in 2016), making the system more detailed. The ICD 10 revised system has not totally replaced the older ICD 9 coding system. ICD codes can be recognized by either a 3 to 5 character numeric code (ICD 9) or a 3 to 7 character alphanumeric code (ICD 10). CPT codes for procedures and services go together with ICD codes for diagnoses. Discrepancies between the two are what medical billing experts are looking for.
HCPCS stands for ‘Healthcare Common Procedure Coding System.’ It is a coding system devised by the Center for Medicare and Medicare Services (CMS). It is the system used by billers to define the procedures used for Medicare, Medicaid and other third party payers. If this sounds like CPT, it is. In fact, many HCPCS codes, what are called the Level I codes are identical to the CPT codes. The Level II codes are different though. They define procedures by non-physicians and are alphanumeric.
Finally, last but not least, are the forms used in billing by physicians (the CMS-1500) and by hospitals, medical clinics and other medical providers (the UB-04).
Medical Billing Expert (MBE)
MBE is a specialized medical billing service that has a team of expert medical billing and coding experts. Our services are designed to ensure that clients and their attorneys get medical bills that are priced accurately and correctly.
MBE’s medical billing review exerts regularly detect coding errors amongst other incorrect billing issues that when rectified save clients thousands of dollars in potential overpayments.