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
● HCPCS CODES
codes
● Used to describe procedures, services, and
technologies, in addition to medical
equipment and medication
● Overlaps with CPT
● Used with Medicare, Medicaid, and many
third- party payers
 ICD
● “InternationalCODES
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

● We’ll 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
 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 third- party payers

● See Courses 2-10 and 2-11 for

more information on HCPCS