A popular question in acupuncture is, what are ICD-10 and CPT codes and why are they important? This article should answer your questions.
Whether you are doing your own billing or hiring a biller, it is very important to understand the medical language around insurance billing and charting diagnosis codes. This is also very important even if you are a cash-only practice, as you may come across needing to send superbills for patients, or motor vehicle claims. A very common question is, “What is the difference between ICD-10 and CPT codes?”
ICD-10
International Classification of Diseases, Volume 10, (ICD-10) is a medical classification system maintained by the World Health Organization that helps create clear and systematic organization of diseases, complaints and conditions. This helps other doctor, practitioners, and third parties, such as insurances, know exactly what the “chief complaint” or reason for visit was.
For example if a patient came in for an acupuncture session with a chief complaint of lower back pain, the ICD-10 that would be noted, charted, and billed for would be “M54.50.”
This would distinguish to other practitioners that are needing to view chart notes, or insurance companies that the patient has lower back pain and not necessarily pain in their thoracic spine (ICD-10 code M54.6).
Do dote that multiple ICD-10 codes can be charted and billed during the same session.
CPT CODES
Current Procedural Terminology (CPT) is a list of descriptive terms used to classify medical procedures, therapeutic exercises and other techniques employed by a healthcare practitioner set by the American Medical Association to help healthcare practitioners use a uniform medical language. Creating this uniform language allows insurance companies as well as other practitioners know exactly what diagnostic technique or procedure was performed during the visit .
For example if a patient receives Acupuncture in your office the CPT code used would be 97810- (Initial 15-minute insertion of needles and personal one-on-one contact with the patient), or if you did electro-acupuncture with a patient the CPT code would be 97813- (Initial 15-minute insertion of needles, personal one-on-one contact with the patient.) Mulitple CPT codes are often used during each visit. These codes often have a time stamp as well as the procedure, technique, or evaluation performed.
SUMMARY
In brief, you need to remember this:
- ICD-10 = diagnosis/complaint
- CPT = services rendered
ICD-10 and CPT codes are important to understand when running a medical practice. ICD-10 codes describe the precise disease or condition that was being treated during the appointment, while CPT codes describe treatment, therapeutic modality, or diagnostic services performed during the treatment.
ICD codes do change semi-regularly so it is best to stay informed or have a current code book in your office, or make sure your biller is up-to-date on the current changes. It is also important to know what CPT codes are covered by certain insurances to make sure you are compensated for your time and work.
References
- International Classification of Disease. World Health Organization. Accessed August 14, 2022.
- CPT Overview and Code Approval American Medical Association. Accessed August 14, 2022.