For billing purposes, what codes are primarily used in Medicare?

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Medicare primarily uses a combination of CPT (Current Procedural Terminology) codes and ICD-10 (International Classification of Diseases, Tenth Revision) codes for billing purposes. CPT codes are utilized to report medical procedures and services provided to patients, which include everything from office visits to surgical procedures. These codes enable providers to detail the type of service or treatment rendered.

On the other hand, ICD-10 codes are employed to classify and diagnose conditions, capturing the medical necessity for the services rendered, which is crucial for reimbursement processes. The accurate pairing of CPT codes with ICD-10 codes helps ensure that claims submitted to Medicare are processed efficiently, reflecting both the procedures performed and the patient's diagnosis.

Utilizing only ICD-10 or focusing solely on either CPT or ICD-9 codes does not align with the current billing practices for Medicare. As of the transition to ICD-10, which took place in October 2015, ICD-9 codes are no longer utilized. This highlights the importance of understanding that a comprehensive approach using both CPT and ICD-10 codes is standard in Medicare billing.

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