This is the second post in a series in which I describe the common types of healthcare data you will come across, namely, diagnoses, procedures, demographic, drug, laboratory result data, clinical notes and financial data. In this previous post, I described diagnose. Here, I describe procedures codes.
Procedure codes serve two primary purposes, clinical record and billing. While doctors use diagnosis codes to record WHY a patient visited, procedure codes tell WHAT was done. They are often used in building dashboards, see my post 6 steps to building medical practice dashboards.
Procedures – Outpatient
Worldwide, medical procedure codes may differ reflecting historical and medical practice differences across countries. In the US, Healthcare Common Procedure Coding System (HCPCS) is the most widely used procedure coding system. HCPCS has levels I and II.
- HCPCS I, also called current procedural terminology (CPT) is intended for physician performed activities.
- HCPCS II is used to code activities, products other than physician performed activites.
For example, a diabetic patient visits the doctor. During the visit, the doctor examined the patient for 20 minutes and ordered a glucose blood test. The doctor records the reason for the visit with diagnosis code ICD10, E11: Type II Diabetes Mellitus.
The doctor then recorded the following procedure codes:
- CPT: 99202 – new patient office visit
- CPT: 82947 – Glucose; quantitative, blood (except reagent strip)
These 5 digit numeric HCPCS I/CPT codes document medical interventions performed by doctors from office visits, to surgery, to laboratory tests and so on.
After the office visit, the doctor’s office could submit claim forms to the billing department of the insurance company of the patient so the insurance company reimburses the doctor. Most of these codes have associated relative value units (RVUs) which indicate the amount of time and effort a physician uses to performed the procedure.
Illustrative example for office visits:
|CPT||Description||Typical minutes||RVU (approx)||Fee|
|99201||new patient, simple||10||0.9||$80|
|99205||new patient, complex||50+||3.5||$400|
HCPCS level II have groups of codes that lead with a Letter chapter heading:
- A codes, transportation, medical and surgical supplies, miscellaneous
- B codes, enteral and parenteral therapy
- C codes, temporary hospital OPPS
- E codes, durable medical equipment
- G codes, temporary procedures and professional services
- H codes, behavioral health/substance abuse services
- J codes, drugs administered other than oral method, chemotherapy drugs
- K codes, temporary codes for durable medical equipment regional carriers
- L codes, orthotic/prosthetic procedures
- M codes, other medical services
- P codes, pathology and laboratory
- Q codes, temporary codes
- R codes, diagnostic radiology services
- S codes, temporary national codes (non-Medicare) codes
- T codes, temporary state Medicaid agency codes
- V codes, vision/hearing services
HCPCS D codes are dental codes.
Procedures – Inpatient
- 0 Medical and Surgical
- 1 Obstetrics
- 2 Placement
- 3 Administration
- 4 Measurement and Monitoring
- 5 Extracorporeal or Systemic Assistance and Performance
- 6 Extracorporeal or Systemic Therapies
- 7 Osteopathic
- 8 Other Procedures
- 9 Chiropractic
- B Imaging
- C Nuclear Medicine
- D Radiation Therapy
- F Physical Rehabilitation and Diagnostic Audiology
- G Mental Health
- H Substance Abuse Treatment
- X New Technology
ICD9-CM follows these chapter headings
- 00-00 Procedures And Interventions , Not Elsewhere Classified
- 01-05 Operations On The Nervous System
- 06-07 Operations On The Endocrine System
- 08-16 Operations On The Eye
- 17-17 Other Miscellaneous Diagnostic And Therapeutic Procedures
- 18-20 Operations On The Ear
- 21-29 Operations On The Nose, Mouth, And Pharynx
- 30-34 Operations On The Respiratory System
- 35-39 Operations On The Cardiovascular System
- 40-41 Operations On The Hemic And Lymphatic System
- 42-54 Operations On The Digestive System
- 55-59 Operations On The Urinary System
- 60-64 Operations On The Male Genital Organs
- 65-71 Operations On The Female Genital Organs
- 72-75 Obstetrical Procedures
- 76-84 Operations On The Musculoskeletal System
- 85-86 Operations On The Integumentary System
- 87-99 Miscellaneous Diagnostic And Therapeutic Procedures
In EHR as well as claims data, you will likely see a primary procedures (main medical intervention) in out patient visits. For inpatient visits, you will likely also see secondary procedures (all other medical interventions, which tend to be numerous in hospital settings). Coding standards recommend having the most costly procedure being the primary, but in practice, the primary procedure may not always be the most complex and costly. More on the structure of healthcare data in a future post…
I’ve compiled ICD10, ICD9, CPT/HCPCS codes in this file that you can reference while learning how to analyze healthcare data.
I’ll describe drug codes in the next post.