4 minutes
Why is the codification of medical events important?
The codification of medical events is the cornerstone of billing in private and hospital medicine.
Each consultation, technical procedure, home visit, or additional examination must be associated with a precise code in order to be covered by the French Health Insurance (Assurance Maladie).
This codification makes it possible to:
calculate the practitioner's fees;
determine the patient's reimbursement;
apply any potential increases and modifiers;
monitor billing compliance.
Whether you carry out a follow-up consultation, an electrocardiogram, an articular infiltration, or a cervical smear test, choosing the correct code directly impacts your remuneration.
1. What does the law say?
The codification of medical events is governed by Article L.162-1-7 of the Social Security Code.
Only procedures listed in the official nomenclatures can be covered by the Health Insurance.
In practice:
the billed code must correspond exactly to the procedure performed;
the procedure must be documented in the medical file;
rules on combining procedures must be respected;
coverage conditions must be verified.
In the event of an audit, the Health Insurance can compare the billed procedures with the elements present in the patient's file.
2. What is the difference between the CCAM and the NGAP?
A doctor can use several nomenclatures during a single consultation.
Let's look at a concrete example.
A patient consults their general practitioner for palpitations.
The practitioner conducts:
a consultation;
an electrocardiogram.
The consultation is coded according to the NGAP. The electrocardiogram is coded according to the CCAM.
The difference between the two nomenclatures therefore depends on the type of procedure performed and not on the professional performing it.
Criterion | NGAP | CCAM |
|---|---|---|
Full name | Nomenclature Générale des Actes Professionnels (General Nomenclature of Professional Acts) | Classification Commune des Actes Médicaux (Common Classification of Medical Acts) |
Primary use | Consultations, visits, and clinical acts | Cell 2-3 |
Professionals concerned | Doctors, dentists, midwives, nurses, physiotherapists, speech therapists, and other medical auxiliaries | Doctors and surgeons performing technical procedures |
Type of pricing | Key letter and increases | Specific tariff for each procedure |
Code format | G, CS, VG, APC... | DEQP003, JKHD001, JLQE002... |
Example (general medicine) | Consultation G (or VG if home visit) | ECG DEQP003 |
Entry into force | 1960s | 2005 |
For doctors, both nomenclatures are often used together. The same consultation can combine an NGAP code for the consultation and a CCAM code for a technical procedure performed during the session.
3. How is a CCAM code broken down?
Each technical procedure has a unique code consisting of: 4 letters + 3 digits
Meaning | Element |
|---|---|
Main anatomical system concerned | 1st letter |
Organ or function | 2nd letter |
Action performed | 3rd letter |
Technique or approach | 4th letter |
Sequential number of the procedure | 3 digits |
Example
DEQP003 (Electrocardiogram):
D: Cardiovascular system
E: Cardiac function
Q: Exploration
P: Functional recording
003: Procedure identifier
JKHD001 (Cervicovaginal smear):
J: Female reproductive system
K: Cervix and vagina
H: Diagnosis
D: Cytological sampling
001: Procedure identifier
GLQP012 (Spirometry):
G: Respiratory system
L: Respiratory function
Q: Exploration
P: Functional recording
012: Procedure identifier
4. How is an NGAP code broken down?
Unlike CCAM, NGAP does not describe a specific technical procedure but rather a category of consultation or care/management.
Key-letter | Meaning |
|---|---|
G | General medicine consultation |
CS | Specialist consultation |
V | Home visit |
VS | Home visit by a specialist |
APC | One-off consultant opinion |
MCS | Coordination surcharge |
Example
A patient consults a general practitioner for chest pain.
The doctor performs:
a consultation;
an ECG.
The billing combines:
G (NGAP);
DEQP003 (CCAM).
5. How to find the code for a medical procedure?
Official databases
The primary reference source remains Health Insurance (l'Assurance Maladie).
Doctors can search for a procedure:
by keyword;
by specialty;
by code;
by anatomical system.
Practice management software
Most medical software includes:
the up-to-date CCAM;
the NGAP;
combination rules;
modifiers;
tariff updates.
Intelligent medical assistants
The new generation of medical assistants makes it possible to automate part of the coding work.
Based on the content of the consultation, these tools can:
suggest relevant NGAP and CCAM billing codes;
detect applicable surcharges;
verify combination rules;
At Aldebaran, this assistance is based on a combination of structured medical knowledge, conventional rules, and artificial intelligence in order to help doctors code their procedures faster and more reliably.
6. Understanding surcharges
Surcharges allow for the enhancement of certain clinical or organizational scenarios.
They are added to the main billing code when the conditions are met.
Among the most frequent:
Surcharge | Situation |
|---|---|
MCS | Coordinated care pathway |
MPC | Specialist surcharge |
MHP | Outside the care pathway |
U | Emergency |
F | Public holiday |
N | Night |
These surcharges are regularly forgotten, even though they can represent a significant portion of the clinic's income.
7. Understanding the rules for combining medical acts
Combination rules determine which acts can be billed together during the same consultation.
They represent one of the most complex topics in medical billing.
The general principle is simple:
Not all acts performed during the same session are necessarily billable in full.
Depending on the case:
some acts can be combined at 100%;
some acts can be combined with a discount;
some acts cannot be combined;
certain exceptions exist.
Why are combination rules complex?
The rules depend on:
the specialty;
the type of act;
the nomenclature used;
modifiers;
changes in agreements.
This is why many doctors prefer to rely on business software or intelligent medical assistants to secure their billing.
8. Which mistakes should be avoided when coding medical acts?
Forgetting a combinable act
Forgetting combinations and surcharges is among the most common causes of under-billing in private practice.
Although there are no consolidated national statistics on the number of forgotten acts each year, medical unions and billing training organisations regularly report that these errors represent several thousand euros in annual loss of earnings for some practices.
Forgetting a surcharge
Forgetting surcharges also represents a significant source of financial loss.
Using the wrong CCAM code
Two similar acts may have different codes.
An error can lead to:
a rejection;
a recovery of overpayments;
an audit.
Failing to comply with regulatory conditions
Some billings require:
a referral letter;
compliance with the coordinated care pathway;
certain age conditions;
a specific clinical indication.
9. What developments are there for the codification of medical acts in 2026?
The year 2026 marks a new stage in the rollout of the 2024-2029 medical convention.
Revaluation of numerous CCAM acts
The CCAM monetary conversion factor has been revalued.
New combinations of NGAP + CCAM
Several technical procedures can now be combined more advantageously with a consultation:
certain infiltrations;
certain spirometries;
the insertion or removal of an IUD;
certain colposcopies.
Revaluation of certain modifiers
Modifiers K and T have been revalued for certain surgical, anaesthetic and obstetric procedures.
New consultations and new codings
The medical convention also continues the revaluation of:
complex consultations;
long consultations;
the monitoring of elderly patients;
certain chronic care treatments.
Conclusion
Medical coding no longer simply consists of choosing between a G consultation and a CCAM act. It is based on a complex set of rules combining nomenclatures, surcharges, modifiers and combination rules.
Understanding the logic of the NGAP and the CCAM is now essential to secure billing, avoid errors and correctly value the medical work carried out on a daily basis.
In a context where nomenclatures are regularly changing, coding assistance tools and intelligent medical assistants are becoming valuable allies in reducing the administrative burden and securing practice income.
French National Health Insurance (Ameli)
National Health Insurance. Common Classification of Medical Acts (CCAM).
National Health Insurance. General Nomenclature of Professional Acts (NGAP). National Health Insurance. Conventional rates for general practitioners and specialists. June 30, 2025.
National Health Insurance. The revaluation of consultations and medical acts.
Professional organisations
MG France: Tariff brochures. 2023-2026
CSMF: New conventional rates applicable as of January 1, 2026
Additional references
Suhard V. History of medical conventions. IRDES, 2022.
French Republic. Public Health Code – Relevant Article (Legifrance). Version in force as of January 1, 2026.
