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F.A.Q. Categories > Health Service Codes

The International Statistical Classification of Disease and Related Health Problems (ICD) provides codes which classify diseases and a wide variety of signs, symptoms, external causes of injury or disease, ect. Each health condition is assigned to a unique category and given its own differentiating code (up to six characters long). ICD9 volumes one and two contain diagnosis codes, while volume three contains procedure codes. (The 9 stands for the ninth revision.)
DRG stands for diagnosis related group. There are approximately 500 groups, with each component of that group characterized by the utilization of similar hospital resources. This helps to classify and group patients who are treated to similar hospital services. Hospitals use these codes to classify cases primarily for the purpose of prospective reimbursement. Additionally, Medicare utilizes these codes to determine how much to pay a hospital since patients with each DRG are similar clinically and have received similar services.
CPT is an acronym for Current Procedural Terminology. This code set is maintained and owned by the American Medical Association (who holds copyright) and describes medical, surgical, and diagnostic services. These codes are designed to communicate/distribute accurate information pertaining to medical services and procedures among various participants of the healthcare arena (primarily physicians and other healthcare professionals).
HCPCS is the Healthcare Common Procedure Coding System (know as hicks-picks). This set of codes is based on the AMA’s Current Procedural Terminology (CPT). HCPCS is a standardized coding system for describing specific items and services delivered in the healthcare setting. Level I of the HCPCS is primarily comprised of CPT codes. Level II of the HCPCS is a standardized coding system that is used to identify products, supplies, and services not included in the CPT codes, such as durable medical equipment (ex: wheelchairs), ambulance services, prosthetics, and supplies.
HCPCS or Healthcare Common Procedure Coding System is the broader category that describes all healthcare procedure coding. CPT codes are commonly considered to be a specific subset of codes that primarily focuses on physician based procedures, or those performed by an individual. These are often considered Level 1 HCPCS. Level 2, or what people most commonly are referring to when they say "HCPCS" are those codes that are not physician based, such as codes for breathing devices, ambulance services, and MRI scans. An example would be E0550 Humidifier, Durable for Extensive Supplemental Humidification.