Question

medical coding question:
How are procedure codes different from diagnosis codes? What items do we need to look for in the medical record to find the correct procedure codes? What does the chapter tell us about HCPCS level 2 codes?

Answer 1

Diagnosis code like international classification of diseases(ICD) help us to know the identify the diagnosis of the individual whereas the procedure codes helps us to know the treatment and services given which helps in the billing process. Medicare and other health insurance programs ensure that these claims are processed in an orderly and consistent manner by use of this standardized coding systems

Check the following in medical records to identify the correct procedure code;

• Review History and Physical, Emergency Department report, and/or Consultant’s Report.
• Review Operative Reports, Special Procedure Reports,and/or Pathology Reports.
• Review Laboratory, Radiology report.
• Review physician progress notes and check the diagnosis.
• Check medication records
• Check the discharge summary

Formulate codes based on the above information and clarify any queries.

The HCPCS is divided into two principal subsystems, referred to as level I and level II of the HCPCS.

Level I of the HCPCS is comprised of CPT (Current Procedural Terminology), a numeric coding system maintained by the American Medical Association (AMA). The CPT is a uniform coding system consisting of descriptive terms and identifying codes that are used primarily to identify medical services and procedures furnished by physicians and other health care professionals. These health care professionals use the CPT to identify services and procedures for which they bill public or private health insurance programs. Decisions regarding the addition, deletion, or revision of CPT codes are made by the AMA. The CPT codes are republished and updated annually by the AMA.

Level II of the HCPCS is a standardized coding system that is used primarily to identify products, supplies, and services not included in the CPT codes, such as ambulance services and durable medical equipment, prosthetics, orthotics, and supplies (DMEPOS) when used outside a physician's office. Because Medicare and other insurers cover a variety of services, supplies, and equipment that are not identified by CPT codes. The level II HCPCS codes were established for submitting claims for these items. Level II codes are also referred to as alpha-numeric codes because they consist of a single alphabetical letter followed by 4 numeric digits, while CPT codes are identified using 5 numeric digits.