ICD-10-CM, ICD-10-PCS, CPT, and HCPCS
If you are new to medical coding, you may not know what these acronyms mean. I certainly had no idea until I started my medical coding courses.
In order to become a proficient medical coder, you will not only need to have a thorough knowledge of medical terminology and anatomy, but also a good understanding of the different code sets.
ICD-10-CM, ICD-10-PCS, CPT, and HCPCS are code sets used to classify medical diagnoses, procedures, diagnostic tests, treatments, and equipment and supplies. These code sets are used for medical billing and statistical purposes.
According to the Centers for Medicare and Medicaid Services (CMS) the three main codes sets used in healthcare are ICD-10-CM, CPT, and HCPCS Level II. ICD-10-PCS is only used in inpatient settings.
The acronyms for the code sets and what they stand for are as follows:
- ICD-10-CM – International Classification of Diseases, Tenth Revision, Clinical Modification
- ICD-10-PCS – International Classification of Diseases, Tenth Revision, Procedure Coding System
- CPT – Current Procedural Terminology
- HCPCS – Healthcare Common Procedure Coding System
Code Sets and Their Definitions
The following are the definitions for each code set.
- Used to report medical diagnoses on claims for services provided
- All providers, including physicians, use it in U.S. healthcare settings
- Providers choose codes according to what is documented in the patient’s medical record
- Centers for Disease Control and Prevention (CDC) developed and maintains this code set
- Used by providers to report procedures performed only in U.S. hospital inpatient healthcare settings
- Physicians do not use this code set to report their services, including ambulatory services and inpatient visits
- Providers select codes according to what is documented in the patient’s medical record
- The Centers for Medicare & Medicaid Services (CMS) developed and maintains this code set
HCPCS Level 1/CPT
- Level I codes and modifiers are the CPT codes
- Used by providers to report medical procedures and professional services provided in outpatient and ambulatory setting, including physician visits to inpatients
- American Medical Association (AMA) developed, copyrighted and maintains this code set
HCPCS Level II/Alphanumeric HCPCS
- Level II codes and modifiers mainly identify products, supplies, and services not included in the CPT codes, such as ambulance services, drugs, devices, prosthetics, orthotics, durable medical equipment, and supplies
- CMS maintains this code set, except for dental services (D codes). The American Dental Association (ADA) developed, copyrighted, and maintains the dental codes
As a coder, it is also important to know the coding guidelines for the code sets, the codes that are accepted by a particular insurance plan, the regulations that need to be followed, and how to be compliant in your coding.