The Difference Between CPT Codes and ICD Codes
Understanding the differences between CPT codes and ICD codes is crucial for therapists and billers navigating the complexities of behavioral health billing. While both play significant roles in the billing and documentation process, their purposes and applications are distinct. Here’s a breakdown of what they are, how they differ, and why they’re important in the context of behavioral health.
What Are CPT Codes?
CPT stands for Current Procedural Terminology. These codes are maintained by the American Medical Association (AMA) and are used to describe the services and procedures provided to a patient. In behavioral health, CPT codes help therapists and billers communicate the type of care given, such as individual therapy, family therapy, or group therapy. Examples include:
- 90837: 60-minute individual therapy session.
- 90847: Family therapy with the patient present.
CPT codes are essential for determining reimbursement rates from insurance companies. They offer a standardized way to document and bill for the time and complexity of services provided.
What Are ICD Codes?
ICD stands for International Classification of Diseases. These codes are maintained by the World Health Organization (WHO) and describe the behavioral health diagnosis or reason for the care provided. Behavioral health professionals use ICD codes to document the conditions they are treating. For instance:
- F41.1: Generalized Anxiety Disorder.
- F33.2: Major Depressive Disorder, recurrent, severe.
ICD codes are also required for insurance claims, as they justify the medical necessity of the services billed using CPT codes.
How Do They Get Confused?
CPT and ICD codes can easily be confused because they often appear together in billing documentation. However, they serve distinct purposes:
- CPT codes answer the question: What was done?
- ICD codes answer the question: Why was it done?
For example, a claim for a 60-minute therapy session (CPT 90837) might list Generalized Anxiety Disorder (ICD F41.1) as the behavioral health diagnosis. Confusion arises when practitioners or billers inadvertently swap the codes or misunderstand their roles, leading to claim denials or delays.
Their Roles in Behavioral Health
In behavioral health, accurate coding is essential for:
- Reimbursement: Insurance companies require both CPT and ICD codes to process claims. Errors can result in underpayment or denial.
- Compliance: Incorrect coding can lead to audits, fines, or other penalties.
- Clinical Documentation: Codes help standardize records, ensuring clarity and continuity of care.
Resources for Further Learning
- Learn more about CPT codes from the AMA
- Explore the ICD codes database maintained by the WHO.
- Review guidance on billing and coding from the American Psychological Association
By understanding and properly using CPT and ICD codes, therapists and billers in behavioral health can ensure accurate billing, streamline reimbursement processes, and maintain compliance—ultimately supporting better care for clients.