Question

What is the importance of knowing proper CPT coding? How does it differ from other codes? Provide examples.

Answer 1

Ans) CPT codes are of primary importance for a few different reasons: They are used by insurers to determine the amount of reimbursement a practitioner will receive under your health insurance coverage (and ultimately how much of the bill you will be left responsible for).

- 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.

- CPT is a nomenclature (a naming system) and ICD-10-PCS is a classification system. Although ICD-10-PCS is used for inpatient reimbursement, the system was created with the underpinning of a classification, not reimbursement.