Essential Guide to Medical Coding Systems: ICD-10, CPT, HCPCS

Understanding Coding Systems Wanita Gregory CPT and HCPCS II Coding Professor P. Haney

What is Medical Coding? transforms healthcare diagnosis, procedures, medical services, and equipment into universal medical alphanumeric codes used in the United States coding is the language used by insurance companies and health care providers requires the ability to understand anatomy, physiology, and details of the services, and the rules and regulations of the payers to succeed

ICD-10-CM- Internal Classification of Diseases, Clinical Modification seven-character, alphanumeric code begins with a letter, and that letter is followed by two numbers alpha characters are not case-sensitive 1st character: alpha 2nd through 7th characters: alpha or numeric 7th character used in certain chapters (obstetrics, musculoskeletal, injuries, and external causes of injury)

ICD-10 Procedure Coding System (ICD-10-PCS) identifies services and treatments used on inpatient services alphanumeric coding requiring 7 digits

Current Procedural Terminology (CPT) also known as service codes identifies medical procedures five-digit code that identifies to health insurance companies what type of care was provided

Healthcare Common Procedure Coding System (HCPCS) standardized code system necessary for medical providers to submit healthcare claims to Medicare and other health insurances comprises two medical code sets, HCPCS Level I and HCPCS Level II. 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.

When are these codes used? ICD-10-CM classifying diagnoses and reason for visits in all health care settings CPT report medical procedures and services for processing claims, conducting research, evaluating healthcare utilization, and developing medical guidelines and other forms of healthcare documentation. HCPCS identify products, supplies, and services ICD-10-PCS used only for inpatient, hospital settings

Improper Coding? directly impact a patient's treatment one of the largest causes of medical coding errors is due to inadequate medical documentation can cause payments to be delayed, denied, or limited practices and providers who have a history of coding mistakes may face fines and or federal penalties for fraud or abuse.

Coding Scenarios ICD-10-CM A football player is going through the normal plays at practice. He gets hit hard during one of the runs. The player was knocked unconscious for less than 30 min. ICD-10-PCS A football player is going through the normal plays at practice. He gets hit hard during one of the runs. The player was knocked unconscious for less than 30 min. S06.0x1A S06.0 Concussion with loss of consciousness of 30 minutes or less, initial encounter S06.0X9A

References https://www.aapc.com/searchresults.aspx?ss360Query=icd%2010%20cm https://www.cms.gov/Medicare/Coding/ICD10/Downloads/032310_ICD10_ Slides.pdf https://www.medicalbillingandcoding.org/hcpcs-codes/