Coding Treatments: Using the CPT or HPCPS

In addition to translating the diagnosis to the appropriate ICD code, medical coders convert the treatment to a CPT code or HCPCS code. The differences are explored below.

Exploring the CPT

Despite how extensive it is, the ICD is just one portion of medical coding, as it covers only diagnoses. There is an entirely separate code set for medical treatments. This code set is called Current Procedural Terminology (CPT), and is copyrighted and maintained by the American Medical Association’s CPT Editorial Panel.

CPT codes refer to the wide range of all medical procedures, including every task and service performed by a medical practitioner. These codes are broken down into three categories. The majority of CPT codes exist in Category I. Category II is reserved for optional performance measurement, and Category III denotes emerging technologies.

Like the ICD system, CPT codes are broken down into categories. Unlike ICD codes, the CPT codes do not exist in detailed tabular format, and are broader in their organization.

Category I is broken down into six main sections:

• Codes for Evaluation and Management: 99201-99499
• Codes for Anesthesia: 00100-01999; 99100-99150
• Codes for Surgery: 10021-69990
• Codes for Radiology: 70010-79999
• Codes for Pathology & Laboratory: 80047-89398
• Codes for Medicine: 90281-99199; 99500-99607

Individual sections are then broken down further. For example:

• Codes for Evaluation and Management: 99201-99499
  • Office/other outpatient services 99201-9215
  • Hospital observation services 99217-99220
  • Hospital inpatient services 99221-99239
    Consultations 99241-99255
  • Emergency department services 99281-99288
  • Critical care services 99291-99292

Because the CPT is copyrighted and run by the American Medical Association, a comprehensive list of codes is generally not made available to the public.

Using the HCPCS

Not all insurance providers accept the CPT. Medicare and Medicaid (both of which will be discussed below) use the Healthcare Common Procedure Coding System (HCPCS). This coding system is comprised of two levels.

Level one consists of the CPT codes and is identical in its implementation. Level two is a coding system that is used to identity medical products and services not included in CPT codes, such as ambulance services, prosthetics, and durable medical equipment. These products and services are usually used outside of the medical practitioner’s office, and Medicare/Medicaid often cover these services where other insurance providers may not.