Library: Policy

317:30-5-4. Procedure and diagnosis coding

Revised 7-1-13

(a) The Authority uses the Health Care Financing Administration Common Procedure Coding System (HCPCS).  This system is a five digit coding system using numbers and letters.  Modifiers are used to further identify services.  There are two sets of codes in the HCPCS system which are maintained by different organizations.  First are the CPT codes, established and maintained by the American Medical Association.  Second, are the second level HCPCS codes assigned and maintained by the Federal Health Care Financing Administration, the American Dental Association, etc.  These codes are common to all Medicare Carriers.

(b) The coding process in the CPT includes a description of the various levels of services and a guide to selecting the codes which appropriately describe the level of services provided.  Normally a physician will perform office, hospital, nursing home and emergency room visits which include the complete range of levels of service from brief to comprehensive.  Physicians who routinely bill only for higher levels of care may appear on utilization reports and will be reviewed and/or investigated to determine if the service rendered matches the level of service claimed.

(c) The Authority accepts the International Classification of Diseases diagnosis coding currently used by the Centers for Medicare and Medicaid Services.