MCCG100 Report 2 Code Set Comparison Table Week Five
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MCCG100 Report 2 Code Set Comparison Table Week Five
JoShell Simmons
Bryant & Stratton College
MCCG100 Intro to Reimbursement/Coding
Mary Caparelli
December 2, 2023
2
Code Set Comparison Table
Coding
System
CPT- Level I
HCPCS
ICD-10-CM
ICD-10-PCS
HCPCS Level II
Definitio
n &
Usage of
Each
Current Procedural Technology Level
I Healthcare Common Procedural Coding System: Reports medical services and procedures furnished by physicians, other
providers, and healthcare facilities.
Classification of
Diseases, Tenth
Revision, Clinical Modification: a system used by
physicians and other healthcare providers to classify and code all diagnoses, symptoms and procedures recorded in conjunction with hospital care in the US. System of assigning procedural codes to procedures associated hospital utilization in the US. Supports data collection, payment, and
electronic health records. A standardized coding system that is used primarily to identify products,
supplies, and services not included in the CPT codes, such as ambulance services, and durable medical equipment, prosthetics, orthotics, and supplies (DMEPOS) when used outside a physician’s office. Setting
of Care
Reports medical procedures and professional services delivered in ambulatory and outpatient settings including physician offices and inpatient visits. A morbidity classification published by the US for classifying diagnoses and reason for visits
in all health care settings. Used only for inpatient, and hospital settings in the US.
Used for supplies
that are used outside a physician’s office. Year
Adopted
Adopted in 1983
Adopted on Oct. 1, 2015
Adopted on Oct. 1, 2015
Adopted in 1983
Frequen
cy of
Updates
Updated annually
by the AMA
Updated annually in July
Updated annually
Updated quarterly
Agency
that
Maintain
s the
Code Set
Maintained by the AMA American Medical Association
Maintained by the CDC’s National Center
for Health Statistics (WHO)
Maintained by Centers for Medicare and Medicaid
Services. (CMS)
Maintained by Centers for Medicare and Medicaid Services (CMS)
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MCC100 Report 2
Healthcare uses coding systems to exchange health-related administrative information. A code set is a shared list of codes that is used in place of longer names or explanations. Code sets classify medical diagnoses, procedures, diagnostic tests, treatments, and equipment and supplies. There are 4 common code sets. CPT – Level I HCPCS (Current Procedural Technology – Level 1 Healthcare Common Procedural Coding System, ICD-10-CM (Classification of Diseases, Tenth Revision, Clinical Modification), ICD-10-PCS (Procedural Codes System) and HCPCS Level II (Healthcare Common Procedural Coding System). Each code set has its own format and structure. CPT – Level 1 HCPCS is
used to bill outpatient and office procedures. This coding system is a uniform
coding process for coding medical services that streamline reporting and increases accuracy and efficiency and is maintained by the American Medical
Association (AMA). CPT codes consist of a five-digit numeric or alphanumeric format, depending on the category. CPT codes are used to report medical procedures and services to Medicare, Medicaid, and other health insurance programs. They are divided into six sections: Evaluation and Management,
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Anesthesia, Surgery, Radiology, Pathology, and Laboratory, and Medicine. An
example of a CPT code would be 90716. This code is used to note the administration of varicella, or chickenpox vaccine. ICD-10-CM Classification of Diseases, Tenth Revision, Clinical Modification is used as a morbidity classification published in the US for classifying diagnoses and reason for visits in all health care settings. ICD-10 is used to code and classify mortality data from death certificates. It is used to help generate healthcare statistics, monitor quality outcomes and mortality statistics, and generate billing claims. The structure and format of the ICD-10-CM is 3-7 characters. Codes longer than three characters always have a decimal point after the first three characters. The first character is alpha, and the second through seventh characters are alpha or numeric. The seventh character is used in certain chapters (obstetrics, musculoskeletal, injuries, and external causes of injury). An example of an ICD-10-CM code would be 125.110, Atherosclerotic heart disease of native coronary artery with unstable angina pectoris. ICD-10-PCS is a system of assigning procedural codes to procedures associated with hospital utilization in the US. These codes will be used to support data collection, payment, and electronic health records. These codes
will help to track various health interventions taken by medical professionals.
ICD-10-PCS has seven alphanumeric characters. Each character is an axis of classification that specifies information about the procedure performed. Within a defined code range, a character specifies the same type of
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information in that axis of classification. The first character is Section. The second character is Body System. The third character is Root Operation. The fourth character is Body Part. The fifth character is Approach. The sixth character is a device, and the seventh character is Qualifier. An example of an ICD-10-PCS code would be 047K0ZZ. This is the code for dilation of a right
femoral artery using an open approach. HCPCS Level II (Healthcare Common Procedural Coding System) is a standardized coding system that is used primarily to identify products, supplies, and services not included in the CPT codes. These are things such as ambulance services and durable medical equipment, prosthetics, orthotics, and supplies (DMEPOS) when used outside a physician’s office. The
structure and format for Level II codes are referred to as alpha-numeric codes because they consist of a single alphabetical letter followed by four numeric digits. The manual is arranged by bold face main terms, which are arranged in alphabetical order. These entries can include tests, services, supplies, orthotics, prostheses, medical equipment, drugs, and therapies, as well as some medical and surgical procedures. These codes contain a generic descriptor that provides the definition of the items that can be billed using that code. The code descriptors use terminology that will include like items into the same code. An example of an HCPCS Levell II code would be C-codes (C1300) which is Temporary Hospital Outpatient Prospective Payment System. D-codes are Dental Procedures. E-codes (E0100) Durable
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medical Equipment, G-codes (G0008) Temporary Procedures and Professional Services. It is important for the code set to be maintained and updated as necessary. It is crucial to keep up with the lates updates and coding changes. By doing so, coder professionals can reduce the number of errors and claims denials, while ensuring accurate reimbursements for their organization. Lack of updating and familiarity with new information can prevent timely processing of claims and cause denials. These updates ensure
that patients get the correct diagnosis and treatment, while improving the overall quality of healthcare for patients. References
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CMS. (2023). Code Sets Overview
. https://www.cms.gov/regulations-and-
guidance/administrative-simplification/code-sets
HCPCS codes & modifiers lookup, HCPCS Codes List - codify by AAPC
. HCPCS Codes & Modifiers Lookup, HCPCS Codes List - Codify by AAPC. (n.d.). https://www.aapc.com/codes/hcpcs-codes-range/
ICD-10-PCS code lookup, ICD 10 procedure codes - codify by AAPC
., ICD 10 Procedure Codes - Codify by AAPC. (n.d.). https://www.aapc.com/codes/icd-10-pcs-codes-range/