Medical INsurance terminology????

[DMickey28]

I am interviewing for a job in Medical Claims Adjusting tomorrow. I have worked in Auto claims but am new to the medical claims. Can anyone give me a rough idea what ICD-9 is? I think it's coding but for what??? Just so I have some idea for the interview...

Also CPT coding????

Thanks!!!

 

[crz4mm2]

One is the diagnosis codes (for medical conditions), the other is the procedure code (what the care provider did).
Good luck on your interview!

Cathy

 

[DMickey28]

Thanks Cathy.

Which one is which????

 

[Auggietina]

ICD-9 is used for diagnosis coding
CPT is used for procedure coding


I've been doing medical billing for over 10 years - let me know if you have any other questions!

 

[crz4mm2]

Auggietina is correct.
Best of luck.
Cathy

 

[Mermaid02]

CPT- Current Procedural Terminology

ICD-9 =International Classification of Diseases (the 9 means it is the 9th revision of the U.S. edition....10 was supposed to come out AGES ago

ICD 9 is used mostly in the hospital setting while CPT is used mostly in the healthcare office.

 

[SonjaB]

ICD-9 is used in medical offices as well, the ICD-9 code is the diagnosis code, which is required on all medical claim forms.

Wanna hear about modifiers next? LOLLLL.......

 

[ahutton]

One thing I've learned in the last 15 years is claims are claims, you just have a different policy form...

Don't forget, you'll see the ICD-9 and CPT codes on a HICFa (called a hick-fa) which is basically the standardized medical bill form.

If as part of auto claims you have done any Medical Payments or Personal Injury Protection claims you have had to do much of the same work as a Medical Claims Adjuster. Same is true for bodily injury claims.

Most of the same laws/regulations apply to medical claims that apply to first party auto claims (requirements for notifying someone if there is a dispute or no coverage, etc.) as the law only specifies if you are making a claim for yourself on your own coverage than time limits apply.

I've had many friends make that shift and do very well and they are much happier than they were having to argue about comparative negligence or the dollar value of a car!

 

[luv2nascar]

You need a few ICD off the top of my head
410 Myocardial Infarction
401 Hypertension
650 Normal delivery for pregnancy
250 Diabetes

CPT are harder because they are 5 digits instead of three

 

[Auggietina]

Actually they are not HCFA 1500 forms any longer - they are CMS 1500 forms.

Same form different name!

 

[WDWAurora]

We must be behind down here in NC! (not all that surprising) We still use HCFAs....the bane (sp?) of my existence when I'm working...why can't those suckers EVER print right? (Or, why can't Courtney remember to put them in so they don't print on white paper? hehe)

 

[Auggietina]

No you are not behind. HCFA 1500 and CMS 1500 are EXACTLY the same form! They just changed the name! It was maybe a year or so now, when HCFA changed its name to Centers for Medicare and Medicaid (CMS) from Health Care Financing Administration (HCFA).

We have the same problem printing them! They are never lined up so they print in the right boxes

 

[DMickey28]

Thanks for all the responses...

ahutton- yes I have dealt with medpay, no pip but RI doesn't have PIP. I think that the transistion will be good... if I get the job!!! I am concerned if the $$$ is about the same though.

I was actually offered more money here, in INdy, for a job that is much more streamlined than the one I was doing in RI.... same title, different company. This new company seems to have less headaches!! I just would like to get a job closer to home and away from the city, hence the medical claims interview.....


wish me luck!!

 

[Sonny76]

I have been in medical claims for 25 years. CPT codes are easy to learn if you remember the first number of the 5. For example: 80000 codes are lab codes, 70000 codes are xrays, etc. As you process claims daily, you will soon get the hang of them and will soon be able to tell if a certain code used is wrong. For example, if the diagnosis is a 250.0, say diabetes, and the doctor bills for an arm xray, you would know right away that the xray was inconsistent with the diagnosis which would prompt either a denial or a phone call to the doctor to find out why they are billing for an xray when they are telling you the patient has diabetes. See what I mean?
If you stick with it, you will learn alot and will always have the knowledge. Good luck!!!!

 

[HoneyPooh]

They will stick in your head like glue! I did cardiology billing for 3 years and the cardio codes are with me for life now! For example right now my MIL is in the hospital with 428.0 (CHF). I hated modifiers. The trick was knowing which insurance companies wanted them and which ones were just confused by them. I also hated "V" codes, yech. I'm doing the billing in the Oral Surgeons office I'm at now but the billing is much simpler for dental insurance and dental medical claims IMHO.