How to Find a CPT Code With an ICD-9 Code

The American Medical Association developed a set of CPT (current procedural terminology) codes that are used for billing medical procedures. The codes provide consistent terminology for specific evaluation and treatment procedures performed by different professionals, including doctors, therapists, laboratory staff, surgeons and radiologists. The ICD-9 (International Classification of Diseases, 9th edition) is a coding system used to assign diagnoses to patients who have received medical care. The two coding systems must be properly combined for medical interventions to be reimbursed by health insurance carriers. Medical coding is a job that requires extensive training; however, any healthcare provider can check whether a particular CPT (treatment) code is covered under the ICD-9 (diagnosis) code given by the physician.

Things You'll Need

• CPT reference manual
• ICD-9 reference manual
• CMS reference manual

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Instructions

• 1

  Determine the ICD-9 code assigned by the physician. For example: 354.0 carpal tunnel syndrome. An ICD-9 code specific to the treatment they provide can also be assigned by other qualified medical personnel. For example, a physical therapist can also assign a 719.44 diagnosis -- hand pain -- a person with carpal tunnel syndrome. An reference manual contains these codes.

• 2

  Use the ICD-9 code to determine which treatment procedures are medically necessary. For example, CPT 31526 -- nasal/sinus endoscopy -- would not be appropriate with the ICD-9 code 354.0 -- carpal tunnel syndrome. However, the CPT code 97110 -- therapeutic exercise -- is an appropriate treatment.

• 3

  Use the CMS (Centers for Medicare and Medicaid Services) reference manual to determine which CPT codes should be used with a specific ICD-9 code to be approved for coverage. Medicare has specific guidelines for medically necessary treatment, and health care facilities typically hire billing and coding specialists to ensure compliance.