CPT, HCPCS and ICD-9-CM are the three common coding systems that doctors use in the United States. Each of these systems is unique and serves a specific purpose in communicating to third-party payers what you did and why you did it. The following summarizes each of these three systems:
• Current Procedural Terminology (CPT), Fourth Edition. Created and maintained by the American Medical Association, CPT consists of over 8,100 codes and modifiers for CPT 2002 for reporting procedures and services. Using CPT codes enables you to communicate to third-party payers what you did. The codes are five-digit numbers accompanied by narrative descriptors. You may also provide two- or five-digit numeric modifiers for additional modification of CPT code descriptions. All third-party entities accept these codes.
Keep in mind that an entirely new section has been added for CPT in 2002. These Category III (Emerging Technology) CPT codes are located in a separate section of CPT, following the “medicine” section. Category III codes are assigned an alphanumeric identifier with a letter in the last field (e.g., 0020T – Extracorporeal shock wave therapy involving plantar fascia). Introductory language has been placed in this code section of CPT to explain the purpose of these codes.
• Healthcare Common Procedure Coding System (HCPCS). HCPCS (pronounced “hick-picks”) was created by the Centers for Medicare and Medicaid Services (CMS). HCPCS is a three-level coding system. Level I is the CPT codes. Level II is a national alphanumeric coding system that begins with a letter followed by four numbers (e.g., Q0185, L8641, L8642). Usually, Level II codes are the codes you use to report supplies, implant materials and injections to Medicare and other payers. Level III is a five-digit alphanumeric code system applicable only within your state. The state Medicare carrier uses it for very unusual procedures for which there is no other level I or level II code available. These codes usually begin with the letters S and W through Z.
• International Classification of Diseases – Ninth Revision-Clinical Modification (ICD-9-CM). This coding system is used to report patient illnesses, injuries, complaints, and/or symptoms, referred to as diagnoses.
Using ICD-9-CM codes allows you to communicate to third-party entities the appropriateness for medical services or why you performed the service. These codes range from three to five digits. For more information on how to use the ICD-9-CM codes properly, see “Essential Guidelines For Using ICD-9-CM Codes” in the March 2001 issue of Podiatry Today.