Medical Billing Codes and Forms
Here is a list of the major forms and coding systems used in medical billing systems:
Evaluation and Management (E/M) Codes
Umbrella term encompassing the three primary types of coding used for medical billing. These include ICD-9 (used for diagnosis), CPT (used for examination, treatment, and procedures), and HCPCS (used to non-physician supplies and services). Each of these three codes are discussed later.
CPT-4 Codes
The CPT-4, also known as HCPCS Level I, is a 5-digit coding system applied to services performed in physician offices, surgery centers and outpatient clinics. CPT codes are grouped by specialty or service, and should correlate with ICD-9 codes.
EDI Enrollment Form
The CMS EDI Enrollment Form must be completed prior being able to submit electronic medical claims (EMC) to Medicare. The agreement must be completed by anyone that intends to submit executed by each provider of health care services, physician, or supplier that intends to submit medical claims electronically.
HCPCS (Level II) Codes
HCPCS Level II is a set of codes used by the federal government to describe non-physician services and supplies. This includes medications, injections, durable medical equipment (DME), dental, vision and hearing services, and transportation services.
HCFA-1500 Form
The HCFA-1500 Form, also known as the CMS-1500 Form, is a paper form used by non-institutional providers to bill Medicare, Part B covered services. It is also used for billing certain Medicaid services.
ICD-9 Codes
ICD codes use 3 to 5 digits to classify diseases, conditions, syndromes and disorders by their diagnosis. Medical billing claims must list ICD-9 diagnosis codes. ICD codes are updates annually.
UB-92 Form
The UB-92 Fform, also known as a CMS-1450 Form, is used by institutional providers to complete a paper-based Medicare, Part A claim for submission to Medicare Fiscal Intermediaries (MFI).
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