CPT, ICD-10-CM, and HCPCS are important code sets used in healthcare coding and claims workflows. They serve different purposes, so practices should understand which code set applies to the information being represented.
What Is CPT?
CPT, or Current Procedural Terminology, is used to report many medical procedures and professional services. CPT codes are maintained by the American Medical Association. Coding should follow the applicable CPT guidance and the documentation supporting the service.
What Is ICD-10-CM?
ICD-10-CM is used to report diagnoses and other conditions. Diagnosis coding communicates the conditions documented for the encounter and can be used with procedure and service information on claims.
What Is HCPCS?
HCPCS includes codes used to report healthcare services, procedures, supplies, and products. Level II HCPCS codes are maintained by CMS and are used for many items and services not represented by CPT alone.
CPT vs ICD-10-CM vs HCPCS
Code Set
General Purpose
Common Use
CPT
Procedures and professional services
Reporting many physician and professional services
ICD-10-CM
Diagnoses and conditions
Reporting documented diagnoses and conditions
HCPCS
Services, supplies, products, and other items
Reporting items and services covered by the HCPCS system
Why Documentation Matters
Code selection should be supported by the documentation and applicable coding guidance. A coding workflow should not assign a code simply because it may produce a preferred reimbursement outcome.
Common Coding Review Questions
Does the documentation support the reported service?
Does the diagnosis coding reflect the documented condition?
Are applicable modifiers supported?
Are payer-specific requirements relevant?
Are code updates reflected in the current workflow?
Does the claim information remain consistent across fields?
CPT generally reports procedures and professional services, while ICD-10-CM reports diagnoses and conditions.
Is HCPCS the same as CPT?
No. CPT is part of the broader HCPCS coding system, while HCPCS Level II contains additional codes used for items and services not represented by CPT alone.
Who maintains these code sets?
CPT is maintained by the American Medical Association. ICD-10-CM and HCPCS Level II are maintained or governed through the applicable U.S. coding and federal healthcare framework, including CMS for HCPCS Level II.
