Medical Coding Basics for Employee Benefits Professionals 

November 9, 2021

First Stop Health

Healthcare billing is incredibly complicated for many reasons. One reason is that all medical bills have a lot of ‘codes’ on them. What are these codes? What do they mean? If you work in healthcare, health insurance or employee benefits, you HAVE TO understand the basics of medical coding. The 4 most common medical codes used in healthcare billing are ICD-10 Codes, CPT Codes, DRG Codes and HCPCS Codes. 

ICD-10 Codes: International Classification of Diseases, 10th Revision: These are diagnosis codes for conditions such as diabetes or pneumonia. They are also the codes for symptoms such as headache or chest pain.  

CPT Codes:  Current Procedural Terminology: These are Procedures codes that describe what is done by the healthcare provider, hospital, etc., such as MRI, gall bladder surgery or complete blood count lab test. CPT codes are also used for doctor's office visits; these CPT codes are also referred to as E/M codes for evaluation and management codes.  

DRG Codes: Diagnosis Related Groups: DRG codes are used for inpatient medical services. A hospitalized patient may have multiple ICD-10 diagnosis codes and multiple CPT codes and these will be 'rolled into' 1 DRG for that hospital stay.  

HCPCS Codes: Healthcare Common Procedure Coding System: HCPCS codes are also procedures codes, but they are for procedures that are not a part of the CPT coding system. Many special medications that are administered in the hospital are coded with a HCPCS code because a CPT code for them does not exist. 

There you have it… a VERY BASIC explanation of medical coding. It’s not that hard once you have a general frame of reference.   

Now you know more about medical coding than 99% of your colleagues. 

Originally published Nov 9, 2021 2:52:29 PM.