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Medical Codes Defined

Posted August 11, 2016

shutterstock_127151537-webIf you work in healthcare marketing, you’ve likely heard various acronyms that stand for different types of medical codes. At Tea Leaves Health, we use the codes within our pre-built queries to identify individuals to be included or excluded from campaigns based on their medical history in their encounter file. Well, if you’ve ever gotten confused by all the names and acronyms, believe us, you’re not alone. Hopefully the following code definitions will provide clarity as you work to reach the right individuals with highly strategic and targeted marketing efforts.


There are a couple of different classifications of coding systems. First, there are diagnosis and procedure codes:
  • Diagnosis codes: Diagnosis codes are tools used to group and identify diseases, disorders, symptoms, poisonings, adverse effects of drugs and chemicals, injuries and various other reasons for patient encounters.
  • Procedure codes: Procedure codes are a sub-type of medical classification used to identify specific surgical, medical, or diagnostic interventions. The structure of the codes will depend on the classification; for example, some use a numerical system, others alphanumeric.
Then, there are ICD, CPT and DRG codes:
  • ICD Codes: ICD stands for International Classification of Diseases. ICDs are codes for diseases, signs and symptoms, abnormal findings, complaints, social circumstances, and external causes of injury or diseases. They are a widely recognized International system for recording diagnoses. The medical classification list is in its 10th revision, the current standard (ICD-10). When the standard moved from ICD-9 to ICD-10, the code set expanded from five positions (first one alphanumeric, others numeric) to seven positions, and went from 13,000 existing codes to 68,000. They have also become much more specific, allowing more information to be conveyed in a code. These codes are used in conjunction with CPT (procedural) codes to record services rendered by a provider to a patient. They are documented in the medical record and then reported to a payer for reimbursement.
  • CPT codes: CPT stands for Current Procedural Terminology. CPT codes are the American Medical Association’s set of healthcare procedure codes. Similar to ICD coding, CPT coding is used to standardize medical communication across the board – but where ICD-9 and ICD-10 focus on the diagnosis, CPT instead identifies the services provided, and are used by insurance companies to determine how much physicians will be paid for their services. There are two levels of codes, Level One and Level Two. Level One codes are numeric, while Level Two codes are alphanumeric and primarily include non-physician services such as ambulance services and prosthetic devices and represent items, supplies and non-physician services not covered by Level One codes.
  • DRG codes: DRG stands for diagnosis-related group. It is a system designed to classify hospital cases into various groups and to identify the products and services that hospitals provide.

Have further questions on what these codes are and how to use them to target those in need of services? Contact us today.