The Difference Between HCPCS and CPT Codes

Did you know that poor billing practices cause American doctors to lose around $125 billion each year? We all know that medical billing and coding has many challenges. If you keep up with our videos or work in the industry, you know exactly what I’m talking about. Even if you’re new here, or just getting started in your career, the American healthcare system should speak for itself - nothing about it is straightforward. So why would it be any easier on the backend?

Don’t panic! I am here to help you avoid unnecessary billing and coding mistakes so you can collect your revenue promptly.

You can avoid putting stress on your billing team by preparing them for the more common mistakes. Preventing denial codes is essential if you want to keep a steady revenue flow.

For example, two terms are commonly misunderstood by billing professionals.

By misunderstood, I mean people usually confuse them for one another. This is an easily preventable billing error, which we are going to focus on today.

HCPCS (Healthcare Common Procedure Coding System) and CPT (Current Procedural Terminology) codes are similar in function, but with important differences.

These two coding systems both handle medical procedures and services. However, HCPCS classifies those procedures and services, while CPT codes describe them. Let’s look deeper into the differences between both codes.

HCPCS and CPT codes are both coding systems that report medical procedures and services. Used frequently in the medical and billing industry, it is important to fully understand the differences between the two. This is especially true when considering revenue cycle management and claim denial percentages. The main difference between these codes lies in their:
* Purpose.
* Structure.
* And Usage.

Developed and maintained by the American Medical Association (AMA), CPT codes describe and report medical, surgical, and diagnostic procedures/services for billing purposes. However, Medicare and other insurances cover a variety of different services and supplies, some of which aren’t identified by CPT codes.

This is why we have HCPCS codes. This is the other main set of procedure codes that classify medical services. Note that HCPCS is closely related to CPT codes, but I’ll get more into that later. These codes assist healthcare workers in reporting different medical procedures and services to health insurance programs, such as Medicare and Medicaid.

For a better grasp of things, let’s go over the structures for each code.
The HCPCS exists in the public domain created by the Centers for Medicare and Medicaid Services. These codes are alphanumeric and fall into two principal subsystems: Level I and Level II. Level I actually consists of the Current Procedural Terminology codes, while Level II identifies products, supplies, and services not covered by CPT codes. When we talk about the difference between the two, we are mostly just talking about HCPCS Level II. Confusing, I know.

Level I, or CPT codes, focuses on codes that report services and procedures performed to payers by physicians, non-physician practitioners, hospitals, laboratories, and outpatient facilities. Level II is the national procedure code set for healthcare practitioners, providers, and medical equipment suppliers which identifies products, supplies, and other services not covered by CPT codes. These include:
* Ambulatory services.
* Durable medical equipment.
* Prosthetics.
* Orthotics.
* Supplies (DMEPOS) when used outside of a physician’s office.

Level II codes consist of one alphabetical letter followed by four numbers. There was a Level III, although this was discontinued in 2003 and is no longer accepted.

Knowing the difference between HCPCS and CPT codes is essential if you work in the healthcare industry. Coders and billing staff can use this knowledge to ensure the most accurate of billing practices. With an accurate billowing practice, you can expect to see better communication within your organization, more timely reimbursement, and compliance with regulations.

#HCPCS #CPTCodes

[mikeggera]

Correction: the slide that addresses HCPCS Level 2 indicates that "ambulatory services" are covered. This should be changed to be "ambulance services". The terms "ambulatory services" and "ambulance services" are quite different.