Medical Coding -
Differences Between Various Code Sets
CPT
- "Current Procedure Terminology"
- Owned and copyrighted by the AMA
- Analogous to the ADA's CDT codes
- Contains over 8,800 codes
- Describe common medical procedures
- These codes are entered in box 24D of a "1500" Health Insurance Claim Form, under CPT/HCPCS column
- Look in this code first; if an appropriate code isn't found, then try the HCPCS
HCPCS
- "HCFA Common Procedural Coding System"
- Developed by the federal government (CMS)
- Used primarily for Medicare and Medicaid to describe procedures or items not listed in the CPT manual
- There is overlap with CPT codes
- Level 1 HCPCS codes are in fact CPT codes
- Level 2 HCPCS codes are unique; begin with a V or W
- These codes are entered in box 24D of a "1500" Health Insurance Claim Form, under CPT/HCPCS column
ICD-9-CM
- "International Classification of Diseases, 9th Edition, Clinical Modification"
- Many dental-related codes are in Section 520 - 529 (Diseases of Oral Cavity, Salivary Glands, and Jaws)
- These codes are entered in box 21 of a "1500" Health Insurance Claim Form, under Diagnosis of Illness
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Written by: Jacob Hodara
