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Experience:  Practicing law since 2000.
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Explain how HIPAA,ICD,CPT and HCPCS influence each of the steps

Resolved Question:

Explain how HIPAA,ICD,CPT and HCPCS influence each of the steps of the medical billing process
Submitted: 7 years ago.
Category: Legal
Expert:  Attorney Wayne replied 7 years ago.

It sounds like youare asking for infomration on the laws and regulations that goverrn medical billing in the United States.

HIPAA is a medical records information statute. While most people know it for providing privacy protections for patient information, it also governs billing for medicare and other federal programs, as well as guidelines that private health insurers use, too.

HIPAA is administered by the federal Dept. of Health and Human Services. Under these powers, this federal department has established the Healthcare Common Procedure Coding System (HCPCS).

You can read about this in greater detail at this government website:

You site two particular sets of codes are relevant for medical billing:

ICD is standard diagnosis code (it stands for International Classification of Diseases). Each ailment (and sometimes separately, depending on the severity or if there are subgroups for that ailment) has a standard code used for billing.

Here's a link with good information:

CPT is a treatment code (it stands for"Current Procedural Terminology"). Codes change as treatments change or are refined and new codes are added.

Essentially, HIPPA ,and a sister law known as MIPPA (Medicare Improvements for Patient and Providers Act of 2008) are the overarching law in this area. MIPPA calls for the Secretary of Health and Human Services to perform an evaluation of the HCPCS codes (which include CPT and ICD).

In sum, HIPPA is the law, HCPCS is coding system governed by the law, and ICD and CPT are types of codes that medical providers use when billing.

I wish you all best.

Attorney Wayne

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