What is the difference between ICD-10, CPT, and HCPCS codes?

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ICD-10, CPT, and HCPCS are three key medical coding systems, each serving distinct purposes in healthcare documentation and billing:

1. ICD-10 (International Classification of Diseases, 10th Revision)

• Purpose: Codes for diagnoses and medical conditions.

• Maintained by: World Health Organization (WHO), with clinical modifications like ICD-10-CM used in the U.S.

• Use: Describes why a patient is receiving care (the medical reason or diagnosis).

• Example:

  • E11.9 — Type 2 diabetes mellitus without complications.

• Scope: Covers diseases, symptoms, injuries, and causes of death.

2. CPT (Current Procedural Terminology)

• Purpose: Codes for medical procedures and services performed by healthcare providers.

• Maintained by: American Medical Association (AMA).

• Use: Describes what healthcare providers did during patient care, especially in outpatient settings.

• Example:

  • 99213 — Office visit for an established patient.

• Scope: Includes surgeries, consultations, evaluations, and diagnostic tests.

3. HCPCS (Healthcare Common Procedure Coding System)

• Purpose: Codes for services, procedures, and equipment not covered by CPT.

• Maintained by: Centers for Medicare & Medicaid Services (CMS).

• Use:

  • Level I: CPT codes (same as above).

  • Level II: Codes for non-physician services like ambulance rides, durable medical equipment, prosthetics, and supplies.

• Example:

  • A0428 — Ambulance service, basic life support.

Summary:

• ICD-10 codes why care is needed (diagnosis).

• CPT codes what care was provided (procedures/services).

• HCPCS codes additional services and supplies not in CPT.

Together, these systems enable precise documentation, billing, and healthcare analysis.

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