Question

Must answer all questions and be 4 paragraphs long for full credit.

Now that we have learned how to use ICD-10-PCS lets discuss why we have three different coding systems, ICD-10-CM, ICD-10-PCS and CPT/HCPCS. Discuss who uses which system(s) and which one did you find the easiest to learn and why? Which one is your favorite system and why?

Answer 1

Ans :   ICD-10-CM, ICD-10-PCS and CPT / HCPCS are medical codes used in U.S for patients and this codes used in different types of field in medical treatment for patient.

ICD-10-CM   (International Classification of Diseases, Tenth Revision, Clinical Modification) is a system used by physicians and other healthcare providers to classify and code all diagnoses, symptoms and procedures recorded in conjunction with hospital care in the United States. It provides a level of detail that is necessary for diagnostic specificity and morbidity classification in the U.S .

The ICD-10-CM is a clinical modification system used exclusively for recording US healthcare.

ICD-10 comprises of two divisions:

• ICD-10-CM (Clinical Modification) which is used primarily for diagnosis coding in all healthcare settings. It has about 68,000 codes.

• ICD-10-PCS (Procedure Coding System) is used only for coding hospital inpatient procedures. It consists of about 76,000 codes.

The above divisions are used only in the US healthcare setting.

The above divisions are used only in the US healthcare setting.

When people mention ICD-10, they are referring to ICD-10-CM.

Importance of ICD-10-CM codes :

ICD-10-CM codes are important because they are more granular than ICD-10 codes and can provide more information about the severity of a patient's condition.

The move to ICD-10-CM from ICD-9-CM was also necessitated by the fact that the latter was running out of code capacity to expand, as most of the code categories were completely full. Additionally, ICD-9-CM codes lacked the specificity and detail provided by ICD-10-CM.

Code structure :

The structure of ICD-10-CM codes is as follows: The first character must be an alpha character, excluding "u." The second and third characters are numeric, and characters four through seven can be a combination of numeric and alpha characters.

The first three characters categorize the injury, and the fourth through sixth characters describe in greater detail the cause, anatomical location and severity of an injury or illness. For certain codes, a seventh character is an extension digit and used to classify an initial, subsequent or sequela (late effect) treatment encounter. ICD-10-CM also uses a placeholder character "X" to allow for future expansion of certain codes.

ICD-10-CM is also divided into an alphabetical index and a tabular list. The alphabetical index is an alphabetical list of terms and the corresponding codes, and the tabular list is a structured list of codes that is divided into chapters that are based on a body system or condition.

ICD-10-PCS : The International Classification of Diseases, 10th Revision, Procedure Coding System (ICD-10-PCS) is a U.S. cataloging system for procedural codes that track various health interventions taken by medical professionals.

Code structure : CD-10-PCS is developed by the Centers for Medicare and Medicaid Services (CMS) in conjunction with 3M Health Information Management to track international morbidity and mortality statistics in a comparable way.

The system uses three- to seven-digit alphanumeric codes to specify medical procedures. The first digit indicates the section of medical practice (surgery, administration, measuring and monitoring, etc.) and the following digits specify the body system, root operation, body part, approach and the device used. The seventh character is a qualifying digit.

The crucial first three digits of a code are stored in the ICD manual for reference.

For example, a code beginning in 0C0 would be a medical/surgical procedure on the mouth or throat -- specifically, an alteration.

Example of an ICD-10-PCS code :

Here is an example of what an ICD-10-PCS code looks like: 047K0ZZ.

This is the ICD-10-PCS code for the dilation of a right femoral artery using an open approach.

CPT - Current Procedural Terminology :

CPT codes are the codes used for reporting surgeries and minor procedures and getting paid. When a claim is filed with the CPT procedure code along with the appropriate ICD-10 diagnosis code, payment is made to the providing practitioner.

Example: CPT codes are essential for getting payment from insurance.

Code 11600 specifies that an excision was done for a malignant lesion including margins and the lesion can be situated either in the trunk, arms or legs and the lesion was 0.5 cm or less.

The CPT system is maintained and implemented by the American Medical Association.

There are three categories of CPT codes:

CPT - used for reporting claims and getting paid. This may be an office visit or Emergency department visit. The correct code level is selected based on some set criteria. The most important factor in determining the level of code is whether the patient in question is a New patient or an already Established one.

• Example, reporting code 99285 will get you payment for an Emergency department visit.

CPT II – Set of supplemental tracking codes that can be used for performance measurement. Example, reporting 2000F will inform the payer that during the 99285 Emergency Department visit above, blood pressure assessment was also done. Often these codes are not recorded because they do not generate revenue.

Category III – These codes are not federally regulated and are fairly new to the healthcare industry. They are reported to help health facilities and government agencies track the efficacy of new, nascent medical techniques. Using Category III codes is important as it keeps the medical fraternity up to date with new cutting-edge developments and medical breakthrough technology.

HCPCS :

Background information :

The HCPCS code set is based on the AMA’s CPT processes. HCPCS was established in 1978 to provide a standardized coding system for describing specific items and services. Initially, facilities voluntarily used HCPCS codes, but with the implementation of HIPAA in 1996, facilities began to report HCPCS for transaction codes. HCPCS has its own coding guidelines and works hand in hand with CPT. HCPCS includes three separate levels of codes:

• Level I codes consist of the AMA’s CPT codes and is numeric.
• Level II codes are the HCPCS alphanumeric code set and primarily include non-physician products, supplies, and procedures not included in CPT.
• Level III codes, also called HCPCS local codes, were developed by state Medicaid agencies, Medicare contractors, and private insurers for use in specific programs and jurisdictions. These are still included in the HCPCS reference coding book. Some payers prefer that coders report the Level III codes in addition to the Level I and Level II code sets. However, these codes are not nationally recognized.

As with CPT, the HCPCS Level II codes standardize similar products and categories for processing the medical claim. The HCPCS codes are primarily used for billing and identifying items and services. These items and services primarily include non-physician based services such as:

• Ambulance services
• Prosthetic devices
• Drugs, infusion additives, and ancillary surgical supplies
• Non-physician services not covered by CPT codes (Level I codes)

Easiest method between ICD-10-CM, ICD-10-PCS and CPT/HCPCS is ICD-10 CM because

The only reason you will be required to used an ICD-10-PCS code is if you are coding an inpatient procedure at a hospital. All outpatient procedures will need to be coded using CPT coding.

Physician practices will need to use CPT for all procedures.

Which is a big relief for many healthcare providers. That's quite a bit of training they can skip. It's not just codes. But anatomy, physiology, terminology and procedures that aren't covered in ICD-10-CM training need to be learned.

And some experts believe the diagnostic documentation is nothing compared to procedural documentation.

So it's a good thing if you don't have to worry about ICD-10-PCS implementation. But will it be a good thing if you do anyway?

Bonnie Cassidy, senior director of HIM Innovation for Nuance the 2011 president of the American Healthcare Information Management Association (AHIMA), thinks there may be compelling reasons to use ICD-10-PCS codes in addition to the CPT codes required.

Basically it comes down to data and using it:

"If you want to be a progressive organization, you need to embark on something that allows you to have better information for analytics. You then will be a step ahead of the game because you’ll have that ICD-10 data in addition to your CPT data."