Code Resources

The following coding books should be consulted when preparing claims. Always use the most current versions and consult the appropriate websites for the latest updates.

CPT Codes

Current Procedural Terminology (CPT) code book. These codes describe procedures and services performed by physicians and other healthcare providers, and are maintained by the American Medical Association (AMA). The CPT code book is published annually and updates are available on the AMA website during the year.

HCPCS - Level II Codes

Healthcare Common Procedure Coding System (HCPCS) code book and its updates are maintained by the Centers for Medicare and Medicaid Services (CMS). The code book is published annually and there are quarterly updates during the year that are posted on the CMS website.

ICD-9-CM and ICD-9-PCS Codes

International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) is maintained by the ICD-9-CM Coordination and Maintenance Committee, consisting of representatives from the American Hospital Association (AHA), CMS, the National Center for Health Statistics (NCHS), and the American Health Information Management Association (AHIMA). These are codes that classify diseases for statistical purposes and should be included on claims submitted to HMSA.

The International Classification of Diseases, Ninth Revision Procedure Coding System (ICD-9-PCS), also known as Volume 3 of ICD-9-CM, is used to code inpatient procedures and was developed by CMS. This code set is published with the ICD-9-CM code set volumes 1 and 2, although the ICD-9-CM volumes 1 and 2 code set can be found published without volume 3. Updates can be found on the CMS website.

DSM-IV-TR

Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision (DSM-IV-TR) is the interim code book that has been updated with code descriptions that reflect current literature, up to 1992. The new version, DSM-V, is expected to be available in 2012.

However, HMSA claims processing requires the use of ICD-9-CM diagnoses. In most cases, DSM-IV-TR codes translate to appropriate ICD-9-CM codes.

ICD-10

Beginning October 1, 2013, all healthcare entities are required to covert their billing, claims processing and medical records systems to ICD-10. ICD-10-CM and ICD-10-PCS will replace ICD-9-CM (Volumes 1 and 2) and ICD-9-PCS (ICD-9-CM Volume 3), respectively. Refer to the CMS website for drafts of the ICD-10.

Revision History