HCPCS vs Procedure Codes: Difference and Comparison

HCPCS and the Procedure Codes are considered to work side by side in what they do. The HCPCS assures the protection of their medical services to the various insurance agencies for safety reasons.

On the contrary, the Procedure Codes keep records of the processes or medication services done to the specific patient. 

Key Takeaways

1. HCPCS (Healthcare Common Procedure Coding System) codes identify medical services and procedures provided by healthcare professionals or facilities. In contrast, procedure codes identify specific medical procedures performed by healthcare providers.
2. HCPCS codes are used for billing purposes and are required for Medicare and Medicaid claims. In contrast, healthcare providers use procedure codes to accurately document the specific medical procedures they have performed.
3. HCPCS codes are updated annually by the Centers for Medicare & Medicaid Services (CMS). In contrast, procedure codes are updated by various organizations, including the American Medical Association (AMA) and the National Center for Health Statistics (NCHS).

HCPCS vs Procedure Codes

HCPCS is a coding system to identify and classify medical procedures, supplies, and services. It is used primarily for billing and reimbursement purposes and includes two code levels. Procedure codes are a subset used to identify specific medical procedures healthcare providers perform. They are used to track patient care, record medical histories, and bill insurance companies.

The HCPCS contain several codes to maintain medical proficiency, comprising three levels: Level 1, Level 2, and Level 3 respectively.

HCPCS requires the use of codes to ensure administration. The next Level 2 coding is used for medical labourers’ services to guarantee the instruments’ medical protection. 

The procedure codes are used in medical facilities with the HCPCS level 1 code. The procedure codes carry the medical systems that the clinical practitioners must follow during any medical service.

There are three categories of the coding system of Procedure Codes Category 1, Category 2, and Category 3 for the various requirements of medical urgency.

Comparison Table

Parameters of Comparison	HCPCS	Procedure Codes
Developer	HCPCS are codes developed by the (CMS).	The procedure codes are developed by the (AMA).
Utilized in the field of	HCPCS codes provide healthcare services to patients.	Procedure codes provide the services that medical workers should be provided with.
Divisions of codes	HCPCS codes have Level 1, Level 2, and Level 3.	Procedure codes possess Category 1, Category 2, and Category 3.
Accessibility	The HCPCS are available for everyone.	Procedure codes are paid facilities for outsiders.
Services	For both direct and non-direct healthcare workers.	Only made with the purpose of procedures operated upon a patient.

What is HCPCS?

HCPCS codes are codes created for medical strategies. It is meant to recognize the protection process which one is qualified for.

Due to the rules passed by HIPAA, the HCPCS has been made available to anyone to access. HCPCS has three levels, each of which is meant to show the required methods. 

Level 1 of HCPCS contains the codes that are also the procedures codes used by the health workers for the services they provide to the patient.

The medical comprises the strategies using codes that must be known while working services on a patient. 

Level 2 of HCPCS has the codes used for emergency vehicle administration with non-actual specialist co-ops. The Level 2 codes of HCPCS are arranged by a capital letter followed by a specific four-digit number for identification.

Code A0021 implies the methods noted for Medical services, supplies of surgeries or transportation purposes, or various other services.

The Level 3 codes of HCPCS are known as the neighbourhood codes and are not used extensively but were acquired from experience until Dec 31, 2003.

After a few years, the medical organisation prepared a more well-founded form of code to show the health insurance of a specific medical program. 

What are Procedure Codes?

The procedure codes adhere to the methodology that a health worker must strictly follow while a health worker is looking for a patient. The board distributes the coding system of procedure codes in the AMA.

The procedure codes comprise three categories.

Category 1 of procedure codes contains six main segments where the codes are used to assess the medical procedures and various research centres and use codes for medication purposes.

Clinical specialists need these codes to carry on with procedures and medical services.

The 2nd category in procedure codes follows the codes that progress the need to follow while assessing and tending to a patient. The leading body of procedure codes – the Performance Measures Advisory Group, makes the required changes and checks this classification.

Even these codes start with four digits followed by a capital letter for identification.

The 3rd category of procedure code focuses on innovation in the medical field. Any third party or outsider association showing the requirements of getting these procedure codes must pay them for doing so.

Main Differences Between HCPCS and Procedure Codes

1. HCPCS is considered the general depiction of the methods and processes a health expert must adhere to while attending to a patient. At the same time, the Procedure codes comprise the codes that show the arrangement of techniques needed to be followed.
2. For the HCPCS codes, HIPAA made it mandatory for anyone to get free access to these codes. While the AMA protects the procedure codes, and, thus is mandatory to be paid before taking assistance.
3. The HCPCS comprises three coding system levels: Level 1, Level 2, and Level 3. On the other hand, the procedure codes are of three categories: Category 1, Category 2, and Category 3.
4. The Centers for Medicare and Medicaid are the authorization by the HCPCS. On the contrary, the AMA is the authorization of the procedure codes.
5. The HCPCS codes can be made used by both direct and indirect medical health workers. Whereas the procedure codes are a guideline to follow while attending to a patient.

References

1. https://www.liebertpub.com/doi/abs/10.1089/wound.2013.0483
2. https://www.sciencedirect.com/science/article/pii/S0895435606000230

Last Updated : 11 June, 2023