Reimbursement codes serve a multi-fold purpose. The major purpose is to receive reimbursement for services rendered or products delivered. These codes represent everything from the type of room (if hospitalized) or the medication prescribed. It includes inpatient and outpatient procedures and durable medical supplies. There are subcategories and modifiers required in some types of codes.

It is also possible to use reimbursement codes to garner statistics. The CPT (Current Procedural Terminology) code collects billable encounters between patients and physicians. Each CPT code has an RVU (Relative Value Unit) assigned to measure the expense incurred by the physician in comparison to the other Current Procedural Terminology codes. This takes into account the work and practice expense. The results can be used to determine reimbursement in relation to geographical location or other statistics.

More Information on Reimbursement Codes

New reimbursement codes are established when new procedures or diagnostic methods are introduced and approved. All requests for CPT codes must be processed by the AMA. Once they are approved, a value is assigned. If the procedure includes work by a physician, the reimbursement code will be higher.

Coding procedures must be followed according to the guidelines for the insurer. Incorrect codes will result in incorrect reimbursement or complete denial of reimbursement for services rendered. Accuracy of coding is usually the responsibility of a medical records transcriber or billing clerk. Many hospitals and clinics outsource this responsibility to companies specializing in medical transcription and billing.