Five medical coding systems are commonly used to manage and identify medical codes. HCPCS, ICD 10, and CPT are codes that correspond to individual diagnoses and procedures. These are used to track the patient’s disease and health condition information and are also crucial in the medical billing process. These are used not only in hospitals but also in government healthcare programs like Medicare. Insurance companies use these codes to ensure that patient healthcare policy covers the services before payment. These included ICD 10 PCS, CPT, ICD 11, ICD 10 CM and HCPCS. In the contemporary healthcare industry, understanding these coding systems has become crucial for the medical billing and coding profession. In this article, the focus will be on exploring the three medical coding systems.
CPT (Current Procedural Terminology)
It is a medical coding system the AMA (American Medical Association) developed. This medical coding system has been used to report surgical, diagnostic, and medical procedures to relevant parties. CPT codes are categorized into three types
- Category I:
It is the most prominent category healthcare professionals use to document procedures and services.
- Category II:
It is used for the performance management of healthcare professionals and to track patients’ health information. It has nothing to do with reimbursement.
- Category III
These are temporary codes that are used to report those procedures and services which are experimental.
It is a procedural system of medical coding classification. It means it is a system used to identify procedures that healthcare professionals use to provide care to their patients. The primary purpose of CPT codes with modifiers is to communicate these procedures standardized for analytical administrative uses. These codes describe specific medical procedures like diagnostic tests, surgeries, and patient visits to healthcare facilities. These codes allow doctors to communicate with insurance companies for billing and reimbursement. These codes comprise five numeric digits and are categorized into three main categories. These categories included evolution management, ancillary services, and procedures.
HCPCS (Healthcare Common Procedure Coding System)
It is an alphanumeric medical coding system developed by CMS. It is a famous coding system for reporting healthcare services, Medicare supplies and procedures, Medicaid, and other insurance plans. The CMS maintains HCPCS. There are two levels of HCPCS codes. These are
- HCPCS Level I codes
- HCPCS Level II codes
The codes of level I of HCPCS are similar to CPT codes used to report physician services. On the other hand, Level II codes are used for medical and pharmaceutical products to report the durability of medical supplies, report supplies, and report non-physician services. HCPCS codes are comprised of four digits and a single letter.
It is the medical coding system that the WHO has developed. The main trigger behind developing the ICD 10 medical code classification system is classifying injuries, health-related conditions, and diseases. ICD 10 is used at the international level for diagnosis coding. These codes offer a standardized way to track and document the disease, describing patient conditions, health determinants, and other characteristics of patients. These codes are also used in billing. It is the World Health Organization that is responsible for the maintenance of the ICD coding system and the international coding modifier format. ICD 10 codes are alphanumeric and comprise 3 to 7 characters. The first characters of the code represent the disease category and are followed by additional characters that provide more specific details.
In short medical coding systems can be very complex, but developing a solid insight into coding regulations and guidelines is essential for reimbursement and reporting. The primary purpose of CPT codes is to report medical procedures and services, while HCPCS codes are used for Medicaid and Medicare reimbursement. However, ICD 10 codes are commonly known as diagnosis codes. These codes are essential in medical billing, healthcare administration, effective communication, and accurate documentation among insurance companies, healthcare providers, and regulatory bodies.
Q 1: How can we identify the CPT Medical Coding System for specific medical services?
Steps can be followed to identify specific codes for medical procedures or services. These steps are
- First, determine medical procedures like surgery, consultation, diagnostic tests, therapies, and other services.
- Then consult with the AMA-published CPT manual that is updated annually and obtain the latest CPT manual in electronic or print format.
- The CPT manual is categorized into sections and subsections, each representing a specific medical procedure category. The main areas of CPT manuals are Anesthesia, radiology, evaluation and management, medicine, pathology, and laboratory.
- Find the appropriate sections in the manual relevant to your coding service or procedure.
- Search particular codes for procedures or services from sections and subsections that further divide the codes and description of codes.
- Then made, the code verification is through reading the description to ensure an accurate representation of the procedure or service.
- Once the code identifies the note for documentation.
Q 2: what are CPT modifiers, and what is their primary purpose?
CPT codes have modifiers that use for the description of service in a specified manner. CPT modifiers indicate if the provider performs multiple procedures, the reason for service, and where the patient procedure occurred. CPT modifiers help ensure healthcare professionals receive accurate reimbursement for their services. Private payers most commonly prefer to use CPT codes to pay healthcare providers.
Q 3: How do HCPCS codes different from CPT, and how can we find these codes?
HCPCS codes are divided into two levels. The codes of level 1 are very much similar to CPT codes used to report physicians’ services. While level II is used for reporting non-physician services not covered under the CPT. HCPCS codes are also a leading source of determining the amount of reimbursement. CPT codes only indicate procedure, not the item under the HCPCS system. These codes can be found in the HCPCS level II manual published by the CMS. Detail description of each code is available in the manual. In addition to it, online tools and software are available to provide access to these codes.
Q 4: what are the medical code sets of ICD 10?
There are two medical code sets of ICD 10. These included
- ICD- 0 CM
As a diagnostic code, it represents disease and conditions, abnormal findings, health problems, and social circumstances. It is a diagnosis code that is only used in healthcare settings.
- ICD 10 PCS
It is a procedural classification system of codes used in hospitals to set reports for inpatient procedures.
Healthcare professionals receive their reimbursement from insurance companies by submitting ICD 10 CM. It represents the patient’s diagnosis and justifies the services rendered as a medical necessity.
Q 5: How to structure the ICD 10 code, and who uses it?
These codes comprise three to seven characters and are organized into chapters. Each chapter represents a disease category. Every code starts alpha character that indicate the chapter or origin of code. The successive two characters after alpha characters are numeric characters. However, the last four characters could be comprises upon either alpha characters or numbers. Information about the chapter, disease etiology, and severity is extracted from the character of the code. Globally these codes are used by healthcare professionals, organizations other entities in the management of healthcare settings.