The following is a refresher on terminologies and coding systems in healthcare.
There are various terminologies and coding systems used in healthcare, and this article will serve as an overview of them.
ICD-10-CM is used to classify diagnoses throughout healthcare and is reported on the UB-04. This coding system reports diagnoses for inpatient, outpatient, home health, long-term care, physician office visits, etc. The National Center for Health Statistics (NCHS) provides oversight for ICD-10-CM. The diagnosis codes are updated twice a year – in April and October – and are up to seven alphanumeric characters. This classification system is also used to assign Hierarchical Condition Categories (HCCs).
ICD-10-PCS is the classification system for inpatient procedures. These codes will be listed on the claim form. Some codes will impact the Medicare Severity – Diagnosis Related Groups (MS-DRGs) and All Patient Refined Diagnosis-Related Groups (APR-DRGs) assignments. The procedure codes are administered by Centers for Medicare & Medicaid Services (CMS). The codes are all seven alphanumeric characters. These codes are also updated in April and October of each year.
ICD-11 is a classification system for diagnoses administered by the World Health Organization (WHO). The classification became effective on Jan. 1, 2022. The United States has not yet adopted ICD-11. This classification system is currently used by 35 countries.
CPT (Current Procedural Terminology®) consists of terminology for surgical procedures, radiology, laboratory tests, occupational therapy/physical therapy/speech and language therapies, patient visits, etc. These codes are used by physician offices and hospitals. The codes are reported for outpatient visits on the UB-04 or physician visits on the 1500. Facilities use the CPT codes in the chargemaster, as well as for outpatient surgeries. The CPT code is five digits and may be augmented by two-digit modifiers. CPT codes are released quarterly. This terminology is owned by the American Medical Association (AMA).
LOINC (Logical Observation Identifiers, Names, and Codes) is the terminology used to electronically report healthcare data. This terminology has six parts and is most frequently used to report laboratory and clinical observations.
SNOMED CT (Systematized Nomenclature of Medicine – Clinical Terms) is the most complete multilingual clinical terminology used in electronic health records. This terminology is used in more than 80 countries.
Rx Norm is a terminology that provides a standardized nomenclature for clinical drugs. This terminology was developed by the National Library of Medicine. The codes provide information on the name of the clinical drug, its ingredients, strengths, and form.
National Drug Codes (NDCs) are different from Rx Norm, as it focuses on the packaging of drugs. This code is frequently included in chargemasters and claim forms to provide information. These codes are administered by the U.S. Food and Drug Administration (FDA). The codes have 10 digits and are listed in three separate sections.
DSM-5 (Diagnostic and Statistical Manual of Mental Disorders, 5th Edition was released in 2013. It is published by the American Psychiatric Association. The most recent version is DSM-5-TR (Diagnostic and Statistical Manual of Mental Disorders, 5th Edition, Text Revision); it was released on March 18, 2022. The Manual includes diagnostic criteria for each mental disorder and lists the ICD-10-CM code, assisting clinicians to ensure that similar cases are grouped consistently.
There are more terminologies and classifications than the nine listed above. It is important to be aware of the classifications and terminologies that are used to report data, to ensure that the data is accurate. It is also important that an authoritative source is used when reporting data.
Programming note: Listen to Laurie Johnson’s live Coding Report every Tuesday on Talk Ten Tuesdays, 10 a.m. EST, with hosts Dr. Erica Remer and Chuck Buck.
