HCPCS codes

Table 10.1. CPT and HCPCS codes related to PET and PET/CT procedures CPT/HCPCS Description...

However, in the United States, the CMS uses these codes for classification of surgical, diagnostic, and therapeutic procedures. Along with CPT/HCPCS codes, Dx (ICD-9-CM) codes must be provided on the claim form for reimbursement. These codes are annually reviewed and updated. A few current representative Dx (ICD-9-CM) codes for the diagnosis of diseases by PET studies are given in Table 10.2. 

Claims for reimbursements must be submitted to the CMS using CPT codes for PET procedures along with Dx (ICD-9-CM) codes for all approved clinical indications. For billing purposes, several CPT codes have been assigned for all PET procedures with a few exceptions, which require HCPCS codes for billing. CPT codes can be used for denial of reimbursement for noncov-ered procedures. Private payers may be billed using CPT codes, while some private payers may require the use of the CMS HCPCS codes. 

The diabetes self-management codes for certified diabetes education programs include the Healthcare Common Procedural Codes (HCPC) GO 108 and GO 109. These two codes specifically describe diabetes education by a recognized provider. The GO 108 code describes a 30-minute individual education session, whereas the GO 109 code describes a 30-minute group education session (CMS, 2006). Each of these standardized codes is used on the billing form, and each code is associated with a specific compensation rate. 

CPT-4 Current Procedural Terminology plus HCPCS Health Care Financing Administration Common Procedure Coding System... 

A variety of controlled vocabiilary codes can be used in some sources for more precise search results. Examples include the North American Industrial Classification System (NAICS), healthcare common procediire coding system (HCPCS), current procediiral terminology (CPT), Universal Medical Device Nomenclature System (UMDNS), and the International Classification of Disease (ICD). However, it is not always easy to determine which information soimce uses which code, if any, and which procedure or disease state the codes cover. 

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