Learning a new field starts with learning its language. This glossary covers the medical coding basics every new coder should know, from A to Z. If you are just getting into the field, read through these terms first. As a result, your coursework and the CPC exam will make more sense.
Medical Coding Basics: Terms A Through I
A: AAPC
The AAPC website is the largest training and credentialing organization for medical coders. It sets the standard for coding credentials such as the Certified Professional Coder (CPC). In fact, Coding Clarified teaches an AAPC approved curriculum.
B: Brackets
In ICD-10-CM, square brackets [ ] in the Tabular List enclose synonyms, alternate wording, or explanatory phrases. In the Alphabetic Index, however, brackets identify manifestation codes.
C: Coding Clarified
Coding Clarified offers an online medical coding course that prepares you to become a Certified Professional Coder (CPC). In as little as 16 weeks, you can complete your schooling and start your new career. Above all, we support you every step of the way.
D: Default Code
A default code is the code listed next to a main term in the ICD-10-CM Alphabetic Index. Coders use it when the documentation does not support a more specific code. In many cases, the default code is also an unspecified code.
E: Emergency Department Internship
Coding Clarified offers an ED Internship to coders who are not current students. To apply, you must already hold a CPC or CPC-A credential. This experience can help you land a better job in the medical coding field. Current students should see letter H.
F: Federally Qualified Health Center (FQHC)
An FQHC is a community health center that serves medically underserved areas and populations. Services often include primary care, dental care, and mental health care. In addition, FQHCs follow special Medicare billing rules, including FQHC specific HCPCS G codes.
G: Group Health Plan (GHP)
A group health plan is a way for one or more employers to provide health benefits or medical care to employees. Coders see GHP information when they determine the primary payer on a claim.
H: HCC Internship
Hierarchical Condition Category (HCC) coding is a risk adjustment model. Payers use it to estimate a patient’s future health care costs. For this reason, accurate HCC coding directly affects reimbursement. Coding Clarified offers an HCC Internship to all of our students.
I: ICD-10-CM
ICD-10 is the 10th revision of the International Classification of Diseases. In the United States, coders use ICD-10-CM to report diagnoses. Therefore, you must know this code set thoroughly to work as a medical coder.
Medical Coding Terms J Through R
J: J Codes
J codes are a subset of HCPCS Level II codes. They mainly report drugs that a provider administers, such as injections and infusions. Hospitals, physicians, and other providers use them on claims.
K: K Codes
The letter K has two meanings in medical coding. In ICD-10-CM, codes K00 through K95 cover diseases of the digestive system. In HCPCS Level II, on the other hand, K codes are temporary codes for durable medical equipment.
L: Local Codes
Local codes were once state or payer specific codes known as HCPCS Level III. However, HIPAA standards eliminated them in 2003. Today, coders use national code sets instead.
M: Medical Coding
Medical coding is the translation of medical documentation into standardized codes. These codes describe why a patient received care and what services the provider performed.
N: NCHS
The National Center for Health Statistics (NCHS) is a federal agency that tracks health information. Along with CMS, it maintains ICD-10-CM and releases the annual updates.
O: Outpatient
An outpatient receives care in a clinic, office, or facility without an overnight hospital admission. Many new coders start their careers as outpatient medical coders.
P: Practicode
Practicode is an AAPC online program that lets new coders practice real world cases in many specialties. Completing it helps you remove the apprentice designation and move from CPC-A to CPC. Learn more about Practicode.
Q: Q Codes
Q codes are temporary HCPCS Level II codes. CMS creates them for drugs, biologicals, and supplies that do not yet have a permanent code.
R: Relative Value Unit (RVU)
RVUs measure the value of a procedure or service. Medicare uses them to calculate physician payment. As a result, understanding RVUs helps you see how code selection affects reimbursement.
Medical Coding Terms S Through Z
S: Scholarships
Coding Clarified partners with workforce boards in many states to offer scholarships. In many cases, you can attend our program at no cost to you. See if your state is on the list and apply now.
T: Tabular List
The Tabular List is the numerical list of ICD-10-CM codes, organized into chapters by body system and condition. Always confirm a code in the Tabular List before you assign it. For example, the Tabular List tells you when a code needs a 7th character.
U: Upcoding
Upcoding is the illegal practice of reporting a more serious or more expensive code than the documentation supports. Its purpose is to increase reimbursement, and it can lead to fines and penalties.
V: V Codes
In ICD-9-CM, V codes described factors that influence health status. In ICD-10-CM, Z codes replaced them. However, ICD-10-CM also has codes V00 through Y99 for external causes, such as transport accidents.
W: Workforce
Many states fund training through local workforce boards under the Workforce Innovation and Opportunity Act (WIOA). Coding Clarified partners with workforce offices across the nation, so eligible students may receive free medical coding training. Apply now for a scholarship through your local workforce office.
X: Placeholder X
Some ICD-10-CM codes require a 7th character but have fewer than six characters. In that case, you add the placeholder X to fill the empty positions. This keeps the 7th character in the correct place.
Y: Y Codes
ICD-10-CM codes in the Y range report external causes, such as the place of occurrence or the activity at the time of an injury. Coders add them as secondary codes to show how an injury happened.
Z: Z Codes
Z codes (Z00 through Z99) report factors that influence health status and contact with health services. For example, they capture routine exams, screenings, and social determinants of health. Some payers do not reimburse Z codes as a primary diagnosis.
Start Building Your Medical Coding Vocabulary
In short, these medical coding basics are essential for your new career. Review them often as you study for the CPC exam. When you are ready to start training, Coding Clarified is here to help.