Do You Need to Know ICD-10-CM, CPT and HCPCS Level 2?

Video Transcript

Host Question:
What are ICD-10, CPT and HSPCS level two, and do you need to know all three of those you do?

Medical Biller and Coder Answer:
ICD-10 stands for International Classification of Diseases, 10th revision, clinical modification, it is all the reasons why a person will go to a doctor. So when you’re trying to get money out of the insurance companies, you have to tell them why the person came to you. What’s wrong with them? Even if it’s they just came for a screening, you still have to say why the person came. So that’s why those codes. CPT Current Procedural Terminology, those are the codes that say what you did for the person. You gave them a shot, you gave them an exam, you gave them a surgery, you gave them a physical therapy treatment. What do you want to get paid for? Those are those codes. They’re attached largely to the money, the HSPCS-2 codes. They’re kind of like the miscellaneous category there is in there. There’s the ambulance rides, the wheelchairs, the codes that are in the other two books, know, the other procedure book that somebody forgot to put in there because whatever, there are certain codes where some insurance companies prefer you to use those level two codes. So they’re kind of like the miscellaneous book you need to know those two, especially depending on what kind of practice of medicine you work in.

Medical Biller and Coder Answer:
These are like big, gigantic library reference books. If you take them like that, they’re updated every year. This is a CPT book. Here’s what this is. So these are all the different codes that have money attached to them. So procedures. So CBT is Current Procedural Terminology. Then you have the ICD-10 book and that’s International Classification of diseases. And that’s kind of like my thing because there’s this very special area of coding called HCC coding that’s attached to ICD tats and that’s a Medicare product and all the insurances have their own form of it. It’s a way of being paid off of the diagnoses. So we’re looking at patients that have a number of issues like their diabetic congestive heart failure. There you’ve got kidney issues, gout and whatever else. So the doctor is using a lot of medical decision making skills on how to take care of this patient.

Host Question:
What are ICD-10 CRM, CBT and CPCS level two and do you need to know all three of those?

Medical Biller and Coder Answer:
The ICD-10 is the diagnosis codes. That’s what we use to say. Why someone is seeing a provider for whatever reason. CBT and the hex fix level two codes are actually part of the same animal. So CBT or HCPCS level one. So those are the same thing, are used for eval management, diagnostic testing and also for surgeries. Whereas the HSPCS level two are used mostly for medical devices, medical supplies and dental codes. And then there’s some other categories there that go for HSPCS-2. And yes, he would want to know all three or at least have some familiarity with all three for this career field. But they do teach you that. And all of the certifications, all of the classes, it’s like a major part of the learning process.

Medical Biller and Coder Answer:
You have some practices that are coming now where they may only do a portion and you need to know all of those. I think you’re always going to have to know because any practice that you work in, that’s what’s going to be used. ICD-10 code, which is the actual diagnosis code for a patient. So if the provider of the patient has hypertension, you have to make sure that everything that’s listed on that particular, you know, in that documentation from the provider links back to those calls or if it’s hypertension or common cold, any of that. We have to make sure that the medication, all of that works with those carriers. If it is a patient for the billing side of them, like the CBC, our biller may not necessarily have to know specifically, but they will learn as they’re looking at codes but like modifiers to be added, you know, by the coding team. So that’s just the even more in-depth look at like the modifier is giving you more details on that. Beeping see how the Current Procedural Terminology from the provider is. Well, if the diagnosis codes.

Medical Biller and Coder Answer:
We are using all of them today. But my experience, I have not used the HSPCS code. Those are more like a project type thing, like we would use them for a new type of interbody disk that we’re trying out, like experimental type codes. And then your ICD-10 is diagnosis codes. Your ICD-10 CM is more inpatient procedure coding, and then CPT is going to be your outpatient procedure coding.