Question

The purpose of this assignment is to gain a better understanding of the code sets used for medical billing. These sets can be complicated, but you will learn in the EHR#8 assignment this week, that the EHR practice management functions for billing can use the clinical information to help you with code selection.

Coding Classification Sets for Medical Coding and Billing

Code Set	When is this Code Set used?	Format	Example	Source
CPT Category I	CPT Category I codes are used to bill medical procedures, technologies, and services	five characters long and may be numeric or alphanumeric.	99215--Office or other outpatient visits for an established patient.	The American Medical Society (AMA)
CPT Category II
CPT Category III
HCPCS Level 1
HCPCS Level II
ICD-9 CM
ICD_10 CM
ICD-10 PCS
ICD-11

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Answer 1

Code Set	When is this Code Set used?	Format	Example	Source
CPT Category I	CPT Category I codes are used to bill medical procedures, technologies, and services	five characters long and may be numeric or alphanumeric.	99215--Office or other outpatient visits for an established patient.	The American Medical Society (AMA)
CPT Category II	CPT Category II codes are supplemental tracking codes used for performance management They are used for measuring performance on quality metrics such as Healthcare Effectiveness Data and Information Set (HEDIS®) , Uniform Data System (UDS), and Physician Quality Reporting System (PQRS)	consisting of four numbers and the letter F, are supplemental tracking and performance measurement codes that providers can assign in addition to Category I codes	3044F Most recent HbA1c level < 7.0%	The American Medical Society (AMA)
CPT Category III	CPT category III codes are temporary codes used to report emerging and experimental services and procedures	consists of four numbers followed by T	0572T Insertion of substernal implantable defibrillator electrode	The American Medical Society (AMA)
HCPCS Level 1	used to report procedures, services, supplies, drugs, and equipment	5 numeric characters; some codes with a fifth alpha character Level I consists of the CPT® code set	33275—Transcatheter removal of permanent leadless pacemaker, right ventricular	The American Medical Society (AMA)
HCPCS Level II	used to report procedures, services, supplies, drugs, and equipment	5 characters, beginning with a letter and followed by 4 numbers	V2599 — Contact lens, other type	The American Medical Society (AMA)
ICD-9	ICD-9-CM is the official system of assigning codes to diagnoses and procedures associated with hospital utilization in USA. It was used until 1999	- a tabular list containing a numerical list of the disease code numbers in tabular form; - an alphabetical index to the disease entries; and - a classification system for surgical, diagnostic, and therapeutic procedures (alphabetic index and tabular list).	0020 Typhoid Fever	Centers for Disease Control and Prevention (CDC) and Centers for Medicare and Medicaid Services (CMS)
ICD-10-CM	It is used to catalog health conditions by categories of similar diseases under which more specific conditions are listed, thus mapping nuanced diseases to broader morbidities.	The ICD-10-CM is divided into the Alphabetic Index, an alphabetical list of terms and their corresponding code, and the Tabular List, a structured list of codes divided into chapters based on body system or condition. The ICD-10-CM Tabular List contains categories, subcategories and codes. Characters for categories, subcategories and codes may be either a letter or a number.	F02.80 and F02.81 represent the manifestation of dementia in diseases classified elsewhere, with or without behavioral disturbance.	Centers for Medicare and Medicaid Services (CMS) and The American Medical Society (AMA)
ICD-10-PCS	ICD-10-PCS is a code set designed to replace Volume 3 of ICD-9-CM for inpatient procedure reporting	ICD-10-PCS codes are composed of seven characters. Each character is an axis of classification that specifies information about the procedure performed. Within a defined code range, a character specifies the same type of information in that axis of classification	X2A5312 Cerebral Embolic Filtration	Centers for Medicare and Medicaid Services (CMS) and The American Medical Society (AMA)
ICD-11	The ICD-11 catalogs known human diseases, medical conditions and mental health disorders used for insurance coding purposes, statistical and tracking of illness and as a global health categorization tool. ICD-11 comes with: - Improved usability - more clinical detail with less training time - Updated scientific content - Enables coding of all clinical detail - Made eHealth ready for use in electronic environments - Linked to relevant other classifications and terminologies - Full multilingual support (translations and outputs)	The codes of the ICD–11 are alphanumeric and cover the range from 1A00.00 to ZZ9Z.ZZ. Codes starting with ‘X’ indicate an extension code. The inclusion of a forced number at the 3rd character position prevents spelling ‘undesirable words’. The letters ‘O’ and ‘I’ are omitted to prevent confusion with the numbers ‘0’ and ‘1’. Chapters are indicated by the first character.	8A00.0Z Parkinson disease, unspecified	World Health Organization (WHO)