Healthcare Common Procedure Coding System

This standardized dialect is also pertinent for medical schooling and teaching in addition to clinical research and studies conducted by scholars, scientists, and physicians by providing a valuable foundation for domestic and coast-to-coast operation evaluations. CPT is used to describe doctor’s services, a vast amount of administrative services in addition to operating services executed in medical facilities, treatment care centers, and outpatient divisions. Providing support for clerical duties and functions such as processing medical claims and initiating strategies and procedures for the evaluation of clinical care is another cause of relevance for CPT. The system also meets the need for tracking trends and identifying improvements, plus progression goals and scaling the value of healthcare services received by patients. The CPT coding system provides physicians throughout the United States with a consistent method for classifying and coding clinical procedures which in return provides a more efficient tool for recording and reporting task that were completed. Physicians, scholars and payors, have been dependent upon CPT to interconnect with other fellow associates, patients,

An accurate and specific documentation of universally accepted set of codes are important for the protection of healthcare providers as well as increased reimbursement for services received. These codes are for the validation of which services the patient received from their health care provider ( (Page, 2009). Having the correct codes in place insures the provider with the information needed by the health insurance carrier. Maintained by the AMA (American Medical Association), this universal numeric assignment is also used for developing guidelines for medical care review as well as data collection for medical education and research (Scott, 2013).

- structure of procedure codes. Codes in ICD-10-PCS have 7 characters where each of them can be either alpha or numeric. Compare to ICD-9-CM, there are 3-4 characters where all characters are numeric.

Due to ICD-9-CMS’ ability to provide necessary detail for patients’ medical conditions or the procedures and services performed on hospital patients, ICD-10-CM/PCS was implemented.

Due to the advances in technology, medical practitioners are more able to retrieve medical information. Coding systems, such as ICD-10-CM, CPT, and HCPCS are used to code and enter such information into a database. These coding systems are useful in administrative and statistical purposes. The Center for Medicare & Medicaid Services, CMS uses a prospective payment services, which was effected in 2012 and 2013 to ensure better health care at lower costs (CMS, 2015).

The CPT coding system was developed in 1983. It is a collection of codes that represent procedures, supplies, products, and services that are provided to Medicare and Medicaid beneficiaries and to individuals enrolled in private health care insurance programs. The CPT codes helps healthcare providers communicate both effectively and efficiently with third party payers about the procedures and services provided to patients. The CPT codes are level I codes and are defined as professional services. Level II codes are National Codes (HCPCS) are alphanumeric codes that are used by providers to report services, supplies and equipment provided to Medicare and Medicaid patients for which no CPT codes exist.

Hospitals are experiencing a greater need for specialized coding services in the wake of the transition to ICD-10. New challenges emerge for hospitals, as ICD-10 has revamped diagnosis and procedure coding and creates the need for hospitals to upgrade to the ICD-10-(PCS) Procedure Coding System if inpatient procedure data is reported.

The Health Care Procedure Coding System Level II Medicare Code books are used when there are certain codes that are not in the CPT-4. There are certain codes like supplies, medical services ambulance, or even equipment that is not covered in the other books so the HCPCS cover that. The HCPCS settings in generally outside of the normal physicians office. There are some times where you would find them at your local PCM appointment or even at the hospital setting. The HCPCS seems to be used widely and is not in one specific location.

Healthcare common procedure coding system (HCPCS) is a standardized coding system that is used to identify supplies and medical equipment in a physician's ambulatory care setting. There are two sets of codes first being level one that includes CPT five digit numeric code and level two that is alpha numeric that begins with a letter followed by four numbers. Physicians must use HCPCS codes on the Form CMS- 1500. Abstracting HCPCS codes is used to describe items used for services and procedures. When abstracting, the procedure, one must look for entries in the chart that describes what was used for the procedure or services. For example, a high strength wheelchair would be coded differently from a ultra lightweight wheelchair or a high strength

The CPT-4 ontology is a national coding method to collect payments for medical services rendered by physicians. It employs a five-character alphanumerical code and are grouped into three categories (AAPC.com, 2016). Category I designate procedures or services. The codes start from 00100 to 99499. Category II codes are extra alphanumeric codes used for measuring performance. Category III codes are used for novel technology, procedures, and services provided to the patient (AAPC.com, 2016). Finally, two-digit modifiers are used to clarify a procedure or service (AAPC.com, 2016).

According to www.aapc.com “Medical coding is the transformation of healthcare diagnosis, procedures, medical services, and equipment into universal medical alphanumeric codes” (What is medical coding, n.d.) Since careers in the field of medical coding is rapidly growing most people would assume that it is a newer practice. However, medical coding’s foundation dates to around the 17th century. Today, the world of medical coding is still changing and evolving just as much as it was years ago. Some of the most commonly used code sets used today are ICD-10CM, CPT, and HCPCS.

ICD-10 stands for International Classification of Diseases, Revision 10. ICD-10 is a revision of the ICD-9 system which physicians and other providers currently use to code all diagnoses, symptoms, and procedures recorded in hospitals and physician practices. There are two main types of ICD-10 coding books, the International Classification of Diseases, Revision 10, Clinical Modification (ICD-10-CM) and the International Classification of Diseases, Revision 10, Procedure Coding System (ICD-10-PCS). ICD-10-CM is a system used by physicians and healthcare professionals to code diagnoses and procedures that occur in American hospitals. ICD-10-PCS is a system of medical classification used for procedural coding. The implementation of

Medical coding is similar to conversion. It is the process of changing medical diagnoses and procedures into numbers, letters, or both. A diagnosis is the process of determining by examination the nature and circumstances of a diseased condition. For every injury, diagnosis, or medical procedure, there is a matching code. There are a number of sets and subsets of code we must be familiar with. The first is the International Classification of Diseases, or the ICD9-CM, which correspond to a patient’s injury or sickness. Next, the Current Procedure Terminology, or CPT codes, is related to the type of services the provider completed on the patient. . Providers use two types of claim forms to bill insurance for a patient’s services and procedures.

Current Procedural Terminology (CPT) is the universal standardized language in the medical industry. Every participant, especially doctors, epidemiologists, coders, payers-insurance companies, government supporting programs such as Medicaid, Medicare, and other professional accredited reporting and recording agencies, financial agencies, and analytical agencies use this coding language to understand exactly what kinds of procedures does certain patient got and what kind of treatment that person received as well as for accurate reimbursement purpose. Another word, this is the universal classification of diseases and diagnosis. Each chapter of CPT starts with specific 5-digit code set being described for a specialty. There are three different

Current Procedural Terminology or CPT codes were developed and are maintained by the American Medical Association or AMA. These codes cover the majority of outpatient medical procedures. It is appropriate that the codes be maintained through the American Medical Association because of the nature of the codes themselves. The codes include the services and materials utilized in each procedure with the AMA monitoring and controlling the codes the people who do the procedures control what is included with them. If an outside agency dictated the codes there would be more of a likelihood of the materials and procedures not keeping up with current accepted medical practice.