Code Set Comparison Table

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Code Set Comparison Table Coding System CPT- Level I HCPCS ICD-10-CM ICD-10-PCS HCPCS Level II Definition & Usage of Each Comprised of current procedural Terminology, a numeric coding system maintained by the American Medical Association. Used to identify products, supplies and services not included in the CPT codes. International Classification of Diseases, tenth revision, Clinical Modification. Used by Physicians and other healthcare providers to classify and code all diagnoses, symptoms and procedures recorded International Classification of Diseases, Tenth Revision, Procedure Coding System. Reporting, Morbidity Statistics and Billing. All Health Care Professionals, health care organizations and insurance programs all use this. Standardized coding system that is used for identifying drugs, biological drugs, and non-biological items. To identify products, supplies and services not included in the CPT-4 Codes. Setting of Care Used for Medicare and Medicaid for reporting medical procedures and services. Outpatient setting Codes applied regardless of healthcare settings. Outpatient Hospital Setting Inpatient Hospital setting Outpatient settings and physician services Year Adopted 1966 1983 1990 1983 Frequency of Updates Quarterly Updates Every Year Every Year Quarterly Updates Agency that Maintains the Code Set American Medical Association (AMA) National Center for Health Statistics (NCHS)of the Centers for Disease Control and Prevention (CDC) National Health for Center Statistics (CDC) Centers for Medicare and Medicaid Services (CMS) The purpose of CPT-Level 1 HCPCS is to identify Medical Services and procedures furnished by Physicians and other healthcare professionals. While HCPCS level 2 identifies products, supplies and services that are not included in the CPT-4 Codes, such as ambulance services and durable medical equipment, prosthetics, orthotics, and supplies. The purpose for ICD-10 CM/PCS are classification systems used for coding diagnoses, procedures and services provided by the US health care system. The format and structure for CPT-Levels 1 and 2 are 5 digits and can be either numeric or alphanumeric, depending on the category they are in. CPT code is clinically focused and utilized common standards so that the coder has a clear understanding across the clinical healthcare model used. The

format and structure of ICD-10-CM/PCS is Seven Characters Alphanumeric code structure. The system uses three to seven digits alphanumeric codes to specify medical procedures, the first digit indicates the section of medical practice and the following digits specify the body system, root operation, body part, approach and the device used. Examples of each one and its description: CPT-Level 1 HCPCS : Anesthesia (00100–01999) Surgery (10021–69990) This is further broken down into smaller groups by body area or system within this code range CPT-Level 2 HCPCS : modifier QW CLIA waived test alerts the payer that the test being reported has waived status under the Clinical Laboratory Improvement Amendments. ICD-10-CM: E10. 9 stands for type 1 diabetes and E11. 9 is type 2 diabetes They include a letter plus two digits to the left of the decimal point, then one or two digits to the right. ICD-10-PCS: 047K0ZZ This is a code for the dilation of a right formal artery using an open approach. It is important to update each code set because it can impact the accurate coding and reimbursement. The issues that can occur are delayed payments or even non-payment, higher rejected, denied or pending claims, reduced cash flows and ultimately lost revenues for the health care providers. There are also new diseases, treatments and medical advances, revising and added or deleted codes. There are many different things that can impact accurate coding and reimbursement and the reasons why this is so important. CPT References: https://www.cms.gov/medicare/coding/medhcpcsgeninfo https://www.medicalbillingandcoding.org/hcpcs-codes/ https://www.cms.gov/medicare/coding/hcpcsreleasecodesets/hcpcs-quarterly-update https://www.cms.gov/Medicare/Coding/MedHCPCSGenInfo/HCPCS_Coding_Questions ICD-10-CM References:

https://www.techtarget.com/searchhealthit/definition/ICD-10-CM https://www.techtarget.com/searchhealthit/definition/ICD-10-CM https://www.cdc.gov/nchs/icd/icd10cm_pcs_faq.htm https://www.cms.gov/newsroom/fact-sheets/cms-0013-p-modifications-hipaa-code-sets-icd-10 ICD-10-PCS References: https://www.techtarget.com/searchhealthit/definition/ICD-10-PCS https://www.advisory.com/daily-briefing/2015/10/01/history-of-icd-10 https://www.cdc.gov/nchs/icd/icd10cm_pcs_faq.htm https://www.cdc.gov/nchs/icd/icd10cm_pcs_faq.htm HCPCS Level II References: https://www.cms.gov/Medicare/Coding/MedHCPCSGenInfo/Downloads/2018-11-30-HCPCS-Level2- Coding-Procedure.pdf https://www.cms.gov/Medicare/Coding/MedHCPCSGenInfo/HCPCS_Coding_Questions https://www.aapc.com/resources/medical-coding/hcpcs.aspx

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