Acronyms, Codes, Terminology: The Language of Medical Billing — With an Accent on Payment

Prime among the many elements that make up a clean claim (one that is accepted for payment by the insurance company), are the codes that correspond to the procedures and diagnoses on the claim, and define the charges paid to providers.

While the Health Insurance Portability and Accountability Act (HIPAA) requires the use of uniform billing codes, or Current Procedural Terminology (CPT®) codes, for all healthcare electronic transactions, not all procedures align with CPT codes. If a CPT code doesn’t exist for a particular diagnosis or procedure, the coder must use the appropriate unlisted code, the Not Otherwise Classified (NOC) code (which often ends in 99, which means there are a lot of them).

It’s really important to know all the terminology relevant to Medical Billing, and stay current with the hundreds of acronyms and constantly updating procedure codes that ensure clean claims, mitigate compliance exposure, and avoid time-consuming denials.