→ Structure, Usage, and Examples

🔹 1. ICD-10-CM (International Classification of Diseases – 10th Revision, Clinical Modification)

📌 Structure:

• Alphanumeric codes: 3–7 characters

• Format: Letter + 2 digits + optional characters
  Example: M16.5 – Unilateral post-traumatic osteoarthritis, hip

🛠 Usage:

• Used to report diagnoses in all healthcare settings.

• Required for insurance claims, epidemiology, and health records.

💡 Example:

• E11.9 – Type 2 diabetes mellitus without complications

• J20.9 – Acute bronchitis, unspecified

🔹 2. CPT (Current Procedural Terminology)

📌 Structure:

• Five-digit numeric codes
  Example: 99213 – Office/outpatient visit, established patient

🛠 Usage:

• Used to report medical, surgical, and diagnostic procedures.

• Required for outpatient and physician billing in the U.S.

• Maintained by the American Medical Association (AMA).

💡 Example:

• 93000 – Electrocardiogram (ECG) with interpretation and report

• 12001 – Simple repair of superficial wound (2.5 cm or less)

🔹 3. HCPCS (Healthcare Common Procedure Coding System)

📌 Structure:

• Level I: CPT codes (numeric, 5 digits)

• Level II: 1 letter + 4 digits (alphanumeric)
  Example: A0428 – Ambulance service, basic life support

🛠 Usage:

• Covers services not included in CPT, such as:

  • Durable medical equipment (DME)

  • Ambulance services

  • Medical supplies

  • Some drugs and injections

• Mainly used for Medicare/Medicaid claims.

💡 Example:

• E0110 – Crutches, underarm

• J1100 – Injection, dexamethasone sodium phosphate, 1 mg

Quick Comparison Table: