LEARN MORE ABOUT

MEDICAL CODING

WHY WE CODE
Coding condenses large amounts of
information
Increases efficiency
Provides a universal language for tracking
the incidence of disease
the efficiency of procedures
performance management within facilities

THREE TYPES OF CODES

ICD codes
Used for describing the diagnosis, injury, and/or
physical status of the patient

CPT codes
Used to describe the procedure or service
performed by the provider, or the technology
used in the service

THREE TYPES OF CODES

HCPCS codes
Used to describe procedures, services, and
technologies, in addition to medical equipment
and medication
Overlaps with CPT
Used with Medicare, Medicaid, and many thirdparty payers

ICD CODES
International Classification of Diseases
United States currently uses ICD-9-CM
International Classification of Diseases, Ninth
Revision, Clinical Modification

ICD-9-CM is going to be updated to ICD-10-CM

in October of 2014
ICD-9-CM: five characters, mostly numeric
ICD-10-CM: seven characters, entirely
alphanumeric

Used in the billing process to demonstrate

medical necessity

CPT CODES
Current Procedure Terminology
Five digits, mostly numeric
Describe medical procedures performed by
the healthcare provider
Different code ranges for different
procedures
Divided into sections on

CPT CODE SELECTIONS

Evaluation and Management

Anesthesia
Surgery
Radiology
Pathology and Laboratory
Medicine
Performance Management (Category II)
Emerging and experimental procedures,
services, and technologies (Category III)

MORE ON CPT
CPT also has modifiers
Add information about the procedure to the code
These modifiers may affect the status of the claim

Well cover these in

CPT Modifiers in Section 2

CPT CODES
Tell the payer which service the healthcare
provider performed on the claim
With ICD codes, CPT codes paint the picture
of the procedure: we performed (CPT code)
because of (ICD code)

HCPCS

Healthcare Common Procedure Coding

System, pronounced hick-picks
Based on CPT
Divided into two levels
First level is identical to CPT
Second level covers services and equipment
not covered in CPT
Like CPT, a HCPCS code should correspond to
the diagnosis code (ICD code) listed on the
claim
HCPCS also has modifiers that are sometimes
used with CPT codes

LEVEL II HCPCS
Includes codes for
Ambulance services
Injectable drugs
Durable medical equipment (like wheelchairs or
splints)
Prosthetics
Many, many other items and services

HCPCS & MEDICARE/MEDICAID

HCPCS was developed by the Center for
Medicare Services (CMS)
HCPCS is used when reporting a claim to
Medicare, Medicaid, and many other thirdparty payers
See Courses 2-10 and 2-11 for more
information on HCPCS