ICD-10, CPT, And HCPCS Medical Codes: Similarities And Differences | Jane Jackson, RN, CRC | RxEconsult

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Similarities And Differences Between ICD-10, CPT, And HCPCS Medical Codes Category: Healthcare Administration by - December 20, 2016 | Views: 76940 | Likes: 0 | Comment: 0  

HCPCS - Healthcare Common Procedures Coding System


HCPCS codes are used to report supplies, equipment, and devices provided to patients as well as procedures not otherwise contained in the CPT system. HCPCS is alphanumeric and is administered by the Centers for Medicare and Medicaid Services (CMS) so please refer to them for specifics. 


CMS includes two levels in its Healthcare Common Procedures Coding System: 

  • HCPCS Level I is the CPT coding system.
  • HCPCS Level II is usually referred to as HCPCS codes.

Okay, that’s where I got lost.  Then I read the following section (it didn’t help):


“Level I of the HCPCS is comprised of Current Procedural Terminology (CPT-4), a numeric coding system maintained by the American Medical Association (AMA). The CPT-4 is a uniform coding system consisting of descriptive terms and identifying codes that are used primarily to identify medical services and procedures furnished by physicians and other health care professionals. These health care professionals use the CPT-4 to identify services and procedures for which they bill public or private health insurance programs. Level I of the HCPCS, the CPT-4 codes, does not include codes needed to separately report medical items or services that are regularly billed by suppliers other than physicians.


Level II of the HCPCS is a standardized coding system that is used primarily to identify products, supplies, and services not included in the CPT-4 codes, such as ambulance services and durable medical equipment, prosthetics, orthotics, and supplies when used outside a physician's office. Because Medicare and other insurers cover a variety of services, supplies, and equipment that are not identified by CPT-4 codes, the level II HCPCS codes were established for submitting claims for these items.”


“Coders today use HCPCS codes to represent medical procedures to Medicare, Medicaid, and several other third-party payers. The code set is divided into three levels. Level one is identical to CPT, though technically those codes, when used to bill Medicare or Medicaid, are HCPCS codes. Level II HCPCS codes are designed to represent non-physician services like ambulance rides, wheelchairs, walkers, other durable medical equipment and other medical services that don’t fit readily into Level I. Where CPT describes the procedure performed on the patient, it doesn’t have many codes for the product used in the procedure. HCPCS Level II takes care of those products and pieces of medical equipment.”


So back to the 99201 office visit with an 1170F attached indicating a functional status assessment was performed, adding HCPCS code S0257 to the claim would let the payer know Advanced Care Planning was also discussed during the visit.  Payment would be processed for the office visit and TWO HEDIS measures would be captured removing them from the future chart review list. 


My confusion begins where there are CPT, CPT II and HCPCS for the same thing.


Example:  Advanced Care Planning – CPT II codes 1157F or 1158F – HCPCS S0257.  Why are there codes in both categories? 


Comprehensive Diabetic Care – Evidence of Treatment of Nephropathy:

  • CPT – 36147, 36800, 36810, 36815,90937 (and many others)
  • CPT II – 3066F
  • HCPCS – G0257, S2065, S9339

Fortunately, my CRC Certification only requires me to be familiar with coding ICD-10.  I hope this has been helpful – although not perfect.


About The Author

Jane Jackson has more than  25 years experience in healthcare, including hospital-based care, home health, and managed care. She enjoys sharing her knowledge and can she be reached at Jane.Jackson@DailyDoseHQ.com. Also visit her blog, Daily Dose HQ.

Also Read:

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List Of HEDIS 2017 Measures 

What Is Managed Care?

What Is The 5 Star Rating System For Managed Care? 

Skills And Requirements For HEDIS Review Jobs

Medicaid Versus Medicare 


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