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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