By DeVry University
April 22, 2022
5 min read
There are currently five major medical coding classification systems that are used to identify and manage medical codes — ICD-11, ICD-10-CM, ICD-10-PCS, CPT and HCPCS Level II. If you’re interested in becoming a medical billing and coding professional, it’s important to learn more about each system.
In this article, we'll start by explaining a little bit about each classification system in medical coding, their differences and some of their specific use cases and advantages in the following sections:
There are 6 main sections of Category I medical codes. They are arranged in numerical order and typically denoted by 5 numeric characters:
99202-99499: Evaluation & Management
00100-01999: Anesthesia
10021-69990: Surgery
70010-79999: Radiology Procedures
80047-89398: Pathology & Laboratory Procedures
90281-99607: Medicine Services & Procedures
Category II medical codes consist of 4 numbers and the letter F, and are tracking and performance codes that can be used by health providers in addition to Category I codes. They document therapeutic, preventative or other interventions, follow-up care, patient history and other aspects of a patient’s care. An example of how a Category II code is used would be to track specific health information about their patients, such as their use of tobacco.
Category III medical codes representing new technologies, services and procedures consist of 4 numbers and the letter T. These new procedures can remain as a Category III designation for up to 5 years. Once proven effective, which may involve FDA approval, they are reassigned Category I codes. If providers do not use them, Category III codes can be eliminated.
The AMA releases new or revised Category III codes semiannually, and Category III deletions annually.
To see what service or procedure a CPT represents, visitthe AMA's website. From there, you'll accept an end-user agreement and create an account. Then, you can enter the 5-digit CPT code to perform a search. You can also enter the name of a treatment or procedure to look up the corresponding CPT code, but you may have to sort through multiple results.
You'll also see that each CPT code is associated with a monetary value. It represents the national average that Medicare pays a provider for the service rendered. Different geographic regions are assigned a relative value amount (RVU), a percentage of the average payment. You can calculate the amount paid in your location by multiplying the average amount by the RVU.
Keep in mind that these values are for Medicare payment. The amount your healthcare provider gets paid may be different if you have private insurance. It could be more or less than the amount listed based on their negotiation with the payer.
