A Breakdown of ICD, CPT, and HCPCS Medical Coding A Breakdown of ICD, CPT, and HCPCS

What is Medical Coding? The process of transforming descriptions of medical diagnosis and procedures into universal medical code numbers Diagnosis codes track diseases and other health conditions Procedure codes track interventions performed

ICD 10 Broken down into two components ICD-10-CM All providers use it in U.S. health care settings Codes are based on documentation in the patients medical record Centers for Disease Control (CDC) develop and maintain codes. ICD-10-PCS Used to report procedures performed in U.S. Hospitals Codes are also based on documentation in the patient’s record CMS developed and maintains

HCPCS Level I codes and modifiers are the CPT codes Level II codes and modifiers are designated for products, supplies and services not included in CPT codes Examples: Drugs Ambulence fees Orthotics Durable medical Equipment

CPT Codes Used to report procedures and services in outpatient/ambulatory settings Codes are developed by the American Medivdical Assosiation

Level II HCPCS Codes used to report supplies, procedures, and cetainprofessonal services notdescribed in the CPT CMS maintains the vode set D-Codes are an exception as they are maintained by the American dental Assosiation

Impact of Incorrect Coding The switch from ICD-9 to ICD-10 has made coding more difficult Codes are now much more descriptive than in previous years A failure to code correctly could affect a patients treatment Just one instance of incorrect can cost a facility million of dllars Consequency could be fines or considered n making the error a legal issue