Level 1: HCPCS

Discuss the difference between Level 1: CPT Codes and Level II: HCPCS National Codes and give an example of each.

CPT was developed by the AMA. CPT is identical to the Level I HCPCS and designed to report medical procedures and services. It is one of the most important coding sets that a medical biller and coder will need to know. A biller or coder will use it for surgeries, tests, evaluations, and other many other medical procedures a health care provider will perform. There are thousands upon thousands of codes to choose wisely from. Without CPT codes a biller wouldn't be able to communicate with the insurance company to get reimbursed for services performed. CPT codes are used in unison with ICD codes to build a picture or story of what was performed on a patient. They are also used to track health

It represents supplies and non-physician services not covered by CPT codes and is alphanumeric always starting with a letter. HCPCS was optional until HIPAA became effective. Now HCPCS are used to describe the use or sale of healthcare equipment and supplies, also known as durable medical equipment (DME), that are not identified in Level I, CPT codes. There is a wide acceptance for this coding between private and public insurers. Required to report most items provided to Medicare and Medicaid patients and by most private payers. Must be used to report procedures to Medicare, Medicaid, and may third-party payers.

Level I CPT code example would be 45378 is used for a colonoscopy and G0105 and 43235 is used for Esophagogastroduodenoscopy, flexible transoral; diagnostic, including a collection of specimen(s) by brushing or washing, when performed (separate procedure).

Level II HCPCS would be used for something like a bath/shower chair, with or without wheels, any size, the code is E0240, and another example would be a general use wheelchair seat cushion, width less than 22 inches, any depth, code is E2601.