Question

What is the difference between HCPCS and CPT coding and the problems people face with looking up HCPCS and CPT codes?

Answer 1

DIFFERENCES BETWEEN HCPCS AND CPT CODES:

HCPCS- Healthcare Common Procedural Coding System

CPT- Current Procedural Terminology.

a) CPT is administered by the AMA (American Medical Association) whereas HCPCS is based on CPT to provide a standardized coding system for the description of specific services and items.

b) CPT was designed to describe medical, surgical and diagnostic services accurately while HCPCS was designed to provide a standardized coding system in order to explain specific items and services provided when health care is delivered.

c) CPT coding is used as a uniform form of communication among physicians, coders, patients and also applicable for those who pay for administrative, financial and analytical purposes. On the other side, HCPCS used in Medicare, Medicaid and other health insurances to ensure the process of efficient insurance claims.

d) CPT codes are holds by AMA, so if anyone interested in finding out the codes must pay a license fee to those who want to compare with Relative Value Unit (RVA) to the CPT codes. HCPCS are public record and can be assessed freely to ensure the accuracy of the process.

PROBLEMS PEOPLE FACING WITH HCPCS AND CPT CODES:

The common problems that people facing in HCPCS and CPT are as follows;

a) Not correctly coding to the highest level of specificity b) Missing of relevant documentation due to lack of knowledge c) Not having adequate access to the provider to understand the claims d) Failure to use of updated or current code sets and e) False reporting of codes or unbundling ( considered as a fraudulent practice).