UNIFORM BILLING SYSTEM – Class 4

Uniform Billing System includes:

  • Current Procedures and Terminology -4 (CPT-4), commonly known as CPT -4 is mainly office based and is procedures oriented
  • International Classification of Disease, 9th Edition, United States version, commonly known as ICD-9 -CM is primarily oriented toward inpatient care

Another change for specialists is the way they bill for their services. Specialist used to use their own billing form, but in the managed care system there is a uniform billing code. MCO’s tend to have a uniform billing system based on codes. Current Procedures and Terminology -4 (CPT-4), commonly known as CPT -4 is mainly office based and is procedures oriented. International Classification of Disease, 9th Edition, United States version, commonly known as ICD-9 -CM is primarily oriented toward inpatient care. These codes can be used to calculate provider’s own average fees and convert them into a per member per month rate to assess MCO contracts. Providers can then calculate (or at least reasonably estimate) their profits when they know the plan members’ average annual use of the services they agree to provide. Providers can set up a chart using their own most frequent CPT codes, their usual and customary fees and the number of times they perform each service in a year.

The developing classification ICD-10-CM (International Statistical Classification of Diseases, Tenth Revision, Clinical Modification) is a replacement for ICD-9-CM, Volumes 1 and 2 (diagnosis). The ICD-10-CM is based on the internationally recognized ICD-10 but provides for additional morbidity detail and will be annually updated.

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