RCCS’ Declassified Coding Survival Guide | 2023 Cpt Code Changes

There are three main types of codes used by medical coding professionals. The International Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10-CM) is published by the Centers for Disease Control (CDC) and the World Health Organization (WHO) and is used for diagnosis coding. This code set undergoes an extensive biannual update each April 1 and October 1, the latest of which took effect on October 1, 2022.

The ICD and its revisions and Clinical Modifications are important tools for consistently identifying and reporting diseases, injuries, and other ailments. This helps the WHO, the United States Government, and other regulatory bodies to identify trends in disease and mortality. It also helps individual patients seamlessly transfer their medical records and history between providers without confusion.

In addition to the ICD-10-CM code set maintained by the CDC and WHO, the American Medical Association (AMA) publishes and maintains Current Procedural Terminology (CPT®) codes for use by physicians, outpatient hospitals, physician offices, Medicare, Medicaid, and private payers. While the ICD-10-CM code identifies the patient’s condition or diagnosis, the CPT® code describes the procedures, treatments, and tests performed and allow the provider to communicate to the payer the services and/or procedure(s) performed and for which they are seeking payment. The use of an established code set ensures continuity in describing and applying coding for the same procedure regardless of who or where the service was provided. The CPT® manual is updated following meetings by the CPT(R) Editorial Panel annually with revisions, deletions, and additions to the entire code set.

Finally, the Healthcare Common Procedural Coding System (HCPCS) Level II code set is maintained by the Department of Health and Human Services (DHS). HCPCS Level II is a standardized coding system used to report supplies, equipment, and services not identified by the AMA’s CPT® code set and updated on a quarterly basis. This includes durable medical equipment, ambulance services, supplies, and innovative procedures. All Level II HCPCS codes are alphanumeric and begin with a letter followed by a series of four numbers. While many organizations think in terms of Medicare reimbursement, some of the HCPCS Level II codes are accepted only by Medicaid, Blue Cross Blue Shield, or by other private payers.

When used together, the ICD-10-CM, CPT®, and HCPCS codes paint a picture to the payer of the services (CPT® and HCPCS) the provider is looking to be reimbursed for, and the ICD-10-CM will determine if the provider will be reimbursed by the payer. Ensuring accurate and current coding is used and applied as outlined by payer guidance is extremely important. Coding changes are published regularly and must be kept up with. The use of outdated or incorrect billing can result in more than a lack of payment.