Question

Let's try to identify the differences in the different code sets used for medical billing in the United States.  Explain the following codeset titles and the types of diagnosis/procedures they include:
 
ICD-10-PCS
ICD-10-CM
CPT

Answer 1

ICD-10PCS stands for International Classification of Disease, 10th Revision, Procedure Coding System. It is developed by the Center for Medicare and Medicaid Services (CMS) and 3M Health Information Management so as to make a comparison between the international mortality and morbidity statistics. It is used in hospital inpatient settings for inpatient procedure coding. It is mandatorily used in all Health Insurance Portability and Accountability Act (HIPAA) transactions.

ICD-10-CM stands for International Classification of Disease, 10th Revision, Clinical Modification. This code is used for all healthcare settings and is the code set for diagnosis i.e. physicians and other healthcare providers use this to classify and code all diagnoses, symptoms and other surgical procedures as per the guidelines of hospital care in the United States. This helps them in systematically storing diagnostic information which can be accessed as and when required. It is also used to tabulate nation mortality and morbidity statistics.

CPT stands for Current Procedural Terminology code. Developed by the American Medical Association it is used to report surgical, medical and diagnostic procedures to physicians, health insurance companies and other accreditation organisations. It has a five character CPT code that helps insurance companies decide how much medical practitioners/healthcare workers should be reimbursed.

They are grouped into 3 categories

Category I- Codes having descriptors range from 00100-99499 accordingly corresponding to a procedure or service.

Category II- They have both alphabetic and numeric tracking codes and used for execution management.

Category III- Provisional codes for new and emerging technology, procedure s and services for data collection and assessment.