What are Diagnostic Codes?

Amy Hunter

Diagnostic codes are a shorthand method for doctors and health insurance providers to communicate. Every disease has a diagnostic code. The physician provides the health insurer with the code in order to receive reimbursement.

Reviewing the paperwork sent from your health insurance provider can give you access to the codes that your physician has entered on your chart.
Reviewing the paperwork sent from your health insurance provider can give you access to the codes that your physician has entered on your chart.

Health insurance companies will only reimburse for certain tests for a particular medical condition. For example, a doctor wouldn’t be reimbursed for a chest x-ray in a patient that had a broken leg. Using a diagnostic code simplifies the billing and reimbursement process.

Health insurance companies will only reimburse for certain tests for a particular medical condition.
Health insurance companies will only reimburse for certain tests for a particular medical condition.

Diagnostic codes are cataloged as ICD9 or ICD10. ICD is an acronym for International Classification of Diseases and the numbers nine or ten clarify which version of ICD code is being used. Many medical practices are still using ICD9, but eventually they will all move to ICD10.

The administration of a chest X-ray makes logical sense if an ICD9 code lists "shortness of breath" as a symptom.
The administration of a chest X-ray makes logical sense if an ICD9 code lists "shortness of breath" as a symptom.

ICD diagnostic codes are updated as more is learned about a disease. The code numbers are not assigned randomly; instead, similar diseases are grouped together. So, for example, if, in the past, a particular medical ailment was considered a psychiatric condition, but we now know that it is a neurological condition, the condition would need to be reclassified.

Coders review medical charts in order to ensure the hospital is reimbursed fully by health insurance companies.
Coders review medical charts in order to ensure the hospital is reimbursed fully by health insurance companies.

There are a variety of reasons why you may want to learn more about diagnostic codes. Reviewing the paperwork sent from your health insurance provider can give you access to the codes that your physician has entered on your chart. This official classification can answer questions that you may have about an undiagnosed medical condition. By understanding the codes, you will learn what your doctor is looking for.

In Western medicine, all medical diagnoses are coded by numbers as established by the International Classification of Disease Manual.
In Western medicine, all medical diagnoses are coded by numbers as established by the International Classification of Disease Manual.

Even if you are not experiencing any health conditions, it makes sense to review the paperwork sent from your health insurance provider. If the diagnostic codes are not related to any testing or condition that you are suffering from then you may be a victim of medical identity theft. In a world where more people are without health insurance, medical identity theft is a growing problem.

While medical identity theft may sound like less of a problem than traditional identity theft, it can have just as great of an impact on your credit. One of the main reasons that people file for bankruptcy is because of outstanding medical bills. If someone uses your identity to receive medical care, you can quickly find yourself under a mountain of bills, no matter how good your insurance plan is.

A broken leg has a specific diagnostic code.
A broken leg has a specific diagnostic code.

You might also Like

Discussion Comments

starrynight

@Azuza - Wow that was so dishonest of those doctors. I'm glad someone caught them!

One of my friends was actually considering going to school for medical billing. However, the program nearest to her doesn't teach ICD-10 yet. She thinks it will be pointless to get a certification right before most places make the switch. She feels like she won't be marketable if she doesn't know ICD-10.

I think she is going to wait til our local program catches up and then get the certification. I think that's a good idea, because in this job market you can't afford to be behind the times on your knowledge!

strawCake

I actually read an article awhile back about doctors committing medical billing fraud with these codes. Most people have no idea how to read a medical bill or what any of the stuff on it says. Most of us just pay them and hope they're correct.

Some doctors were taking advantage of this by billing the insurance companies for procedures they didn't actually do and pocketing the money. Eventually a medical biller who was a patient of one of these doctors figured out what was happening and blew the whistle on these crooks!

Speechie

@geekish - I was curious as well, because I am a speech language pathologist as well and was never taught explicitly about the diagnostic codes.

From what I could tell from a little research, physical therapy schools do not teach explicitly about the codes as well!

My graduate school is constantly changing the classes as needed; I will have to suggest this as a part of one of the classes!

geekish

I thought it was interesting that we were never taught these codes in speech language pathology graduate school.

Although we do not need to use them in school settings (instead there are individualized education plans); they are vital to us and our clients being reimbursed by insurance companies.

Are these codes taught in other therapy oriented schools such as physical therapy or occupational therapy?

anon180956

DX stands for Diagnosis.

anon93210

I am trying to find out what a DX code is.

Post your comments
Login:
Forgot password?
Register: