Guided Notes
The Code Sets: ICD-10-CM, ICD-10-PCS, CPT & HCPCS
What each code set is for, who maintains it, how codes look, when they update, and which ones go on physician vs hospital claims.
Four code sets, four jobs
Slide 1 / 5| Code set | Describes | Used on | Example |
|---|---|---|---|
| ICD-10-CM | Diagnoses (why) | All claims | E11.9 type 2 diabetes w/o complications |
| ICD-10-PCS | Inpatient hospital procedures | Hospital inpatient claims | 0DTJ4ZZ appendix removal, laparoscopic |
| CPT (HCPCS Level I) | Services & procedures by providers | Physician & outpatient claims | 99213 established office visit |
| HCPCS Level II | Supplies, drugs, equipment, some services | Mostly Medicare/Medicaid, outpatient | E0114 crutches, J1100 dexamethasone 1 mg |