The Difference between Illness and Disease in Medical Coding/Billing

As a medical biller or coder, you must know the difference between illness and disease. Just as you may be ill but not be suffering from a disease, you may be suffering from a disease but not feel ill.

Most of the codes that you encounter as a biller/coder have something to do with a patient’s illness. Illness is a catch-all term that refers to a feeling or condition of not being healthy. Although an illness may be due to a disease, a disease has measurable symptoms, and it affects normal body functions.

Be sure that you really grasp the difference between illness and disease. Just as you may be ill but not be suffering from a disease, you may be suffering from a disease but not feel ill. A patient may have influenza, an illness, for example, but that doesn’t mean she’s suffering from a disease. Conversely, a patient may have Type 2 diabetes, a disease, but she may not feel bad or be experiencing obvious symptoms.

During a patient encounter, the physician examines the patient, documents his findings, and then determines the best course of action for treatment. When performing this type of service, the physician bills for an evaluation and management encounter (also known as an E&M visit), which is a fancy way of referring to a doctor’s visit, or a consultation (a visit requested by another physician or healthcare entity).

Whether a physician conducts an E&M visit or a consultation, he or she will report some sort of illness or disease-related term in the patient’s record, even if the problem is something as simple as the common cold.

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