Code Comparison Essay and Table
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Medicine
Date
Feb 20, 2024
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There are four distinct types of code sets used for coding, CPT (Current Procedural Terminology)- Level I HCPCS (Health Care Common Procedure Coding System), ICD-10 CM, ICD-10-PCS and HCPCS Level II. I will be addressing the importance and purpose of the four code sets, along with the format and description of each. Lastly, I will discuss why updating the codes and what effect it has on the current reimbursement and coding.
First, CPT (Current Procedural Terminology) - Level I HCPCS was implemented in 1966
to provide a uniform coding system to report physician services. “Specifically, CPT codes are used to report procedures and services to federal and private payers for reimbursement of rendered healthcare, each CPT code represents a written description of a procedure or service, eliminating the subjective interpretation of precisely what was provided to the patient.” (2022, AAPC). In the CPT manual it lists the Introduction, Evaluation and Management, Anesthesia, Surgery, Radiology, Pathology and Laboratory, and Medicine sections. “CPT codes includes five
characters. Most codes are numeric, but some codes have a fifth alpha character, such as A, F, T, or U. Examples include: 33275 Transcatheter removal of permanent leadless pacemaker, right ventricular, including imaging guidance (e.g., fluoroscopy, venous ultrasound, ventriculography, femoral venography), when performed” (2022, AAPC). The Healthcare Common Procedure Coding System (HCPCS) Level II was to accurately report services not coded under CPT. HCPCS also includes the codes not approved yet through CPT. HCPCS Level II codes are made up of five characters. The first is a letter and the remaining four are numbers. An example would be “G9631: Patient sustained ureter injury at the time of surgery or discovered up to 30 days (about 4 and a half weeks) post-surgery" (2022, AAPC).
Next, ICD-10 PCS (Procedural Coding System) was developed to improve the classification system and to provide more detail yet also allowed for the expansion of the coding system to incorporate new and emerging technology, and treatment modalities. “All ICD-10-PCS
codes have seven characters all under each category, section, body system, root operation, body part, approach, device, and qualifier. Each character position in the PCS represents a category of information about the procedure” (2022, AAPC). An example is “EXTRACORP. Assist. and Performance, Physiological Systems, Assistance, Cardiac, Continuous, Output, Balloon Pump- 5,
A, 0, 2, 2, 1, 0” (2022, AAPC). ICD-10 CM is used in healthcare settings to report disease information. The ICD-10-CM codes contain three to seven characters to describe patient conditions. These include symptoms, syndromes, diseases, and other reasons. “Every code begins with an alpha character, which is indicative of the chapter to which the code is classified. The second and third characters are numbers. The fourth, fifth, sixth, and seventh characters can be numbers or letters. An example of an ICD-10 code and the condition it represents: G10 (Huntington's disease)” (2022, AAPC).
Finally, there are times when the coding sets are updated, CPT updates once a year on January 1
st
, HCPCS updates quarterly, ICD-10 CM and ICD-10 PCS updates annually every October. This information is important to keep up with as a coder because you want to ensure you are reporting the correct information regarding the care or services patients have received. If everything is correct, then it can make the process of payment more efficient, and it will have 1
less of a chance to result in denied or long-term pending claims. You want to make sure you are updating codes to prevent healthcare organizations from a loss of revenue. 2
Code Set Comparison Table
Coding
System
CPT- Level
I HCPCS
ICD-10-CM
ICD-10-PCS
HCPCS
Level II
Definition &
Usage of
Each
Current Procedural Terminolog
y- the Introduction
, Evaluation and Managemen
t, Anesthesia, Surgery, Radiology, Pathology and Laboratory, and Medicine sections
International Classification
of Disease, 10th Edition, Clinical Modification- reporting disease information (morbidity) for reimburseme
nt, data reporting, research, and quality of care monitoring
The International
Classification
of Diseases, 10th Edition,
Procedural Coding System- was
developed to
accommodat
e the expansion of
the coding system to incorporate new technology and treatment methodologi
es The Healthcare Common Procedure Coding System-
durable medical equipment, services, and medications
Setting of
Care
inpatient and outpatient settings
hospital settings
hospital and inpatient settings
Outpatient
Year Adopted
1966
October 1
st
,
2015
October 1
st,
2015
1983
Frequency of
Updates
January 1
st
every year
Annually every October
Annually every October
Quarterly Agency that
Maintains
the Code Set
the American Medical Association (AMA)
The National Center for Health Statistics (NCHS)
the Centers for Medicare and Medicaid Services the Centers for Medicare and Medicaid Services (CMS)
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(CMS)
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Resources: AAPC. (2022). AAPC Medical Coding – Code Sets. https://www.aapc.com/resources/medical-
coding/code-sets.aspx
CMS. (2022). Code Sets Overview. https://www.cms.gov/Regulations-and-Guidance/Administrative-Simplification/Code-Sets
CMS. (2022). Health Care Code Sets: ICD-10. Retrieved from https://www.cms.gov/outreach-
and-education/medicare-learning-network-mln/mlnproducts/downloads/icd9-10cm-icd10pcs-cpt-
hcpcs-code-sets-educational-tool-icn900943.pdf
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