Q&A Silly question but confused. How to know when to use ICD or CPT.

[Julie Hadley]

I know this sounds ridiculous but I've been learning about ICD-9/10 coding and CPT but somehow I still don't know when you are using an ICD code or when you're using CPT or HCPCS codes. If anyone can tell me when I'm suppose to use what that would be a huge help. I feel silly for even asking but either my book doesn't directly say it (or I'm looking over that part) or I'm just not understanding it.

 

[Alicia Scott]

Don't fret Julie. Here is an easy to keep them apart:
ICD-9 is what is wrong with a patient.
CPT is what is being done to the patient.
HCPCS are extra codes, often used for Medicare patients. These codes supplemental codes.

 

[Ruth Sheets]

Just adding my 2 cents...
ICD stands for International Classification of Disease. So these are needed to specify the disease or diagnosis.
CPT stands for current procedural terminology. So these are the procedures, treatments, and work that the doctor does.

Doctors won't get paid for the work they do (CPT codes) unless the diagnosis (ICD codes) match up as being related. So doctors just can't do any procedure w/o justification that it is needed.

HCPCS... for equipment and some procedures. The best way to familiarize yourself is just to study the HCPCS manual and see what is there, and to do lots of practice examples.

Just so you know, when I first began I would frequently look for codes in the wrong book and wonder why I couldn't find it. You will overcome this problem with some more practice, too!

 

[MaryjoP]

I know this sounds ridiculous but I've been learning about ICD-9/10 coding and CPT but somehow I still don't know when you are using an ICD code or when you're using CPT or HCPCS codes. If anyone can tell me when I'm suppose to use what that would be a huge help. I feel silly for even asking but either my book doesn't directly say it (or I'm looking over that part) or I'm just not understanding it.

I was just trying to figure out the same exact thing and about to email Alicia on that as well!! Not a stupid question. I'm sure we aren't the only ones.... So ironic I just found this and so happy to get my answer!!! Thank you.

 

[Carolyn Heath]

I agree with both Alicia and Ruth. When I took the PMCC class in 2010, this was what my instructor told the class about ICD-9/ICD-10 and CPT/HCPCS:
ICD-9/ICD-10: Why is the patient seeing the doctor? (This is a clue to find the diagnosis code.)
CPT/HCPCS: What is being done for the patient? (This is a clue to find the procedure code.)