The three code sets
- ICD-10-CM describes diagnoses and the reason for the visit
- CPT describes procedures and services, including E/M visits
- HCPCS Level II covers supplies, drugs, equipment and some services not in CPT
Modifiers
Modifiers explain special circumstances without changing the code. Modifier 25 indicates a significant, separately identifiable E/M service on the same day as a procedure. Modifier 59 and the X{EPSU} modifiers indicate a distinct procedural service. Use them only when documentation clearly supports them.
NCCI edits
The National Correct Coding Initiative identifies code pairs that shouldn't normally be billed together and sets medically unlikely edits (unit limits). Check edits before submission to avoid denials.
Keep code sets current
ICD-10-CM updates each October and CPT each January. Make sure your software and coding references are updated on time.
Frequently Asked Questions
When do code sets change?
ICD-10-CM updates take effect October 1 each year, and CPT updates take effect January 1, with some interim releases.