Procedure Codes

ND320 AIHCND C01 L02 A07 Prodedure Codes

Key Points

Procedure Codes: the categorization of the medical codes during an encounter.
It's important to note if a procedure is inpatient or outpatient.

Key Procedure Code Sets

The graphic above shows some additional information about 3 of the important code sets. Here are the key points about each of them.

ICD10 PCS: Procedure Coding Systems
- Only for Inpatient
- 72,000+ codes as of 2019
- Focus on medical and surgical
CPT: Current Procedural Terminology
- Outpatient focused but can apply to physician visits in ambulatory settings
- 10,000+ codes as of 2019
- Focus on professional services by physician
HCPCS: Healthcare Common Procedure Coding System
- Inpatient and outpatient
- Has 3 levels
- L1: CPT Codes
- L2: Non-physician services
  - DME: Durable Medical Equipment
  - Ambulatory Services
  - Dental
- L3: Medicare/Medicaid related

We will focus on ICD-10 PCS and CPT codes, but it's good to be aware of HCPCS codes, too!

ICD10-PCS Code Structure

7 alphanumeric characters [A-Z, 0-9]
1st character is the Section
- Reference Section codes categories in the table above
Subsequent characters relate to the Section and give:
- Body System
- Body Part
- Approach
- Device used for a procedure

Additional Resources

PCS Procedure Code System

PCS Code Example

For this example we used 027004Z.
This is a Heart Surgery code that relates to:

Dilation of Coronary Artery
One Site with Drug-eluting Intraluminal Device
Open Approach

You can see the breakdown in the image above.
In the table, you can see that this code starts with 0, which is the Medical category.
If you look over the link from the last section, PCS Procedure Code System, you can further see where the rest of the code breaks down.

0 = Medical
2 = Heart and Great Vessels
7 = Dilation
0 = Coronary Artery, One Site
0 = Open Approach
4 = Drug-eluting Intraluminal Device
Z = No Qualifier

Additional Resources

Code Sets

SOLUTION:

ICD10 - PCS

PCS Code Quiz

SOLUTION:

02724TZ

CPT Codes

CPT codes have the following structure:

Up to 5 numbers
3 Categories
- Category 1: Billable codes
- 10 sections largely split along biological systems which are broken out in the image above
- Category 2:
- Five digits that end in F
- Non-billable
- Performance measure focused on physicals and patient history
- Category 3:
- Services and procedures using emerging technology

Generally, you'll focus on the first two categories.

As a reminder, we will not be covering HCPCS Codes. However, we have added some additional links regarding HCPCS codes below.

Additional Links

CPT Code Quiz

QUIZ QUESTION::

Match the CPT Code with the correct high level Category (1,2,3) or Billable Code Category, if it has one.

ANSWER CHOICES:

CPT Code	Category
49878
97563
3875F
79832

SOLUTION:

CPT Code	Category
97563
49878
79832
3875F

Code Sets Quiz

QUIZ QUESTION::

Match the correct code set to its attributes.

ANSWER CHOICES:

Attibutes	Code Set
10,000+ Codes
Focus on medical and surgical
72,000+ codes
Has 3 Categories
Has 3 levels
Up to 5 numbers
Up to 7 alphanumeric digits
Focused on Outpatient
Only Deals with Inpatient

SOLUTION:

Attibutes	Code Set
10,000+ Codes
Has 3 Categories
Up to 5 numbers
Focused on Outpatient
Has 3 levels
10,000+ Codes
Has 3 Categories
Up to 5 numbers
Focused on Outpatient
10,000+ Codes
Has 3 Categories
Up to 5 numbers
Focused on Outpatient
Focus on medical and surgical
72,000+ codes
Up to 7 alphanumeric digits
Only Deals with Inpatient
Focus on medical and surgical
72,000+ codes
Up to 7 alphanumeric digits
Only Deals with Inpatient
Focus on medical and surgical
72,000+ codes
Up to 7 alphanumeric digits
Only Deals with Inpatient
Focus on medical and surgical
72,000+ codes
Up to 7 alphanumeric digits
Only Deals with Inpatient
10,000+ Codes
Has 3 Categories
Up to 5 numbers
Focused on Outpatient