What Is the Difference Between CPT and ICD Codes?

What Is the Difference Between CPT and ICD Codes?

11 Jan 2022
5 min
What Is the Difference Between CPT and ICD Codes

Did you know that there were almost 3.5 million hospital admissions last year?

With a statistic that large, it's easy to see how complicated it can be to keep track of various patients in a hospital. From diagnosis to treatment and beyond, one slip-up could result in a disaster. One way you can note conditions and distinguish between them is by using CPT and ICD codes.

Familiarizing yourself with these codes is not only helpful but also essential. Are you asking yourself, "What is the difference between CPT and ICD codes?" Keep reading to learn about it with this guide.

What Are CPT and ICD Codes?

CPT stands for Current Procedural Terminology. These were created by the American Medical Association (AMA). The first CPT codes date all the way back to the late 60s.

Since then, they've helped the healthcare industry describe and diagnose a wide variety of activities. Whenever a healthcare provider meets with a client or patient, these codes make it clear what happened at that time. They're even used by federal government programs like Medicaid, as well as private payers.

There's no denying that the universality of CPT codes has added an extra dimension of efficiency to the overall system in the United States.

ICD stands for International Classification of Disease. This list of codes was first introduced by the World Health Organization (WHO) in the mid-90s. Since then, these codes have become a standard way of diagnosing illnesses and causes of death.

These codes are also essential components of the health insurance industry. Without them, billing and getting remuneration would end up being a complicated labyrinth. Once you familiarize yourself with these codes, you'll see how they simplify the process.

This is true not only for the health insurance industry but for hospital operations as a whole.

These codes often remain the same but sometimes they can be updated by WHO or AMA. Rather than being regular, updates can come once a year, every few years, or even after four years or more. Since even a small change can alter how something is billed or processed, it's crucial to stay in the loop and avoid missing the updates when they become available.

Examples of CPT Codes and Their Meaning

If you conduct a CPT code lookup, you'll notice that some CPT codes are more commonly used than others. For instance, one of the most billed CPT codes in recent times was 90837. This is a code that refers to a psychotherapy session that lasts for one hour.

As long as the psychotherapy session lasted for at least 53 minutes, then billing this particular CPT code is allowed. Behavioral health therapists often have sessions that last for about an hour rather than half an hour or even several hours, so this is why this code is more common than some other types.

It's important to note that the description for code 90837 used to include sessions that were conducted "with or without a family member." This would mean that you could bill this code during couple or family therapy sessions. Since that portion has been removed, it's crucial to utilize the list of CPT codes relevant to that type of therapy session.

The family therapy code for a session of one hour is 90847, while the couples therapy session code is 90846. It's true that some codes pay more than others, but getting them wrong could result in legal trouble. Even if the mix-up was an honest mistake, it could still cause suspicion of fraud.

This is why it's so important to have a system in place that will allow you to avoid these kinds of mix-ups. This is especially true when you're dealing with employees who are still on the learning curve. They may not have had the opportunity to memorize each code for insurance billing.

Examples of ICD Codes and Their Meaning

Are you aware that almost 265 million people worldwide have some kind of anxiety disorder? With this statistic in mind, it should come as no surprise to learn that the ICD code for anxiety disorder is the single most-used code in the United States healthcare system.

The specific code is F41.1. This is for general anxiety disorder, but sometimes anxiety isn't as clear-cut as that. For instance, the second most popular ICD code is F43.23 which refers to "adjustment disorder with mixed anxiety and depressive mood."

In fact, most of the popular ICD codes deal with anxiety, depression, adjustment disorder, or some combination of these mental health issues. For example, there's F43.22 which stands for "adjustment disorder with anxiety," F33.1 for "major depressive disorder, recurrent, moderate," and F43.21 for "adjustment disorder with depressed mood."

Some mental health issues are temporary and may even manifest a single time during someone's life. If someone has experienced only one major depressive episode that was moderate, then a physician should use the F32.1 ICD code.

Other codes also make a note of whether the episode has been isolated so far or shows signs of being recurrent. There's sometimes an indicator of whether it was moderate, major, or unspecified.

Since there are so many different codes that overlap in their definitions, it can end up being all too easy to confuse one ICD code with another.

This is yet another reason why you should have a proper telehealth software system in place to avoid any of these confusions, especially when the quality of patient care is on the line.

What's the Best Way to Distinguish Them?

Without a proper telehealth platform, hospitals would be far less efficient than most of them are. The best platforms have a wide range of functions that allow healthcare professionals to input their diagnoses using the appropriate CPT and ICD codes. These can then be looked up by any other relevant medical employee who needs access to the medical records.

It's also important to send messages regarding those diagnostic codes when necessary. For instance, if you need to send a patient from one floor to another or one doctor to another, then these functions are crucial.

With so many different platforms and software tools out there, you might be wondering which ones are worth the investment and which should be avoided. One way you can make a more informed decision on a specific software provider is by trying out a demo. If you have to pay for the demo or none is offered, then these are red flags that suggest you should look for your telehealth solution elsewhere.

Upvio Is the Best Solution

Upvio is not just a telehealth platform. It also provides appointment scheduling features, forms builder, instant messaging, reminders, virtual waiting room and face vitals scanning, among many other vital functions. Best of all, Upvio's products are compliant with both HIPAA and GDPR.

Instead of including basic features and calling it a day, Upvio has striven to provide a more efficient experience all around through expert innovation. For instance, you have the ability to customize your telehealth scheduling options.

That way, you can have an interface that works for you. Plus, you can add features and branded items that a user would expect, such as your logo and links to your website.

Since no-shows can end up sabotaging productivity and using up available resources, Upvio's software has taken measures to reduce the impact by a significant degree. Instead of allowing patients to forget about upcoming appointments, Upvio sends automated reminders via email and SMS. Staff members are also notified in real-time of any changes in an appointment, including whether one has been canceled or rescheduled.

Upvio's digital forms also provide a new level of productivity for everyone involved. Rather than outdated paper and clipboard, new and returning patients can fill out their forms at a self-service station. This allows the desk staff to handle other matters.

Upvio also makes it easy to create forms for specific clients or general purposes, such as adding boxes that request the information you need. This can all be done in the program with no knowledge of code whatsoever. As if that wasn't amazing enough, the patient's data is then synced seamlessly to the patient portal.

What Is the Difference Between CPT and ICD Codes?

Has a colleague ever asked you, "What is the difference between CPT and ICD codes?" Now that you've learned about it with this in-depth guide, you can explain the difference to them in as much detail as possible. That way, your entire team will be on the same page and work as a much more cohesive unit.

To make things even more efficient, Upvio offers a telehealth powerhouse of software and more. From appointment scheduling and form building to messages and reminders, you won't know how you got on without these tools before.

Contact us to book a custom demo or try it for FREE!

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