Information can be compared and shared across regions, hospitals, and settings using a common language.
To effectively distinguish between CPT and ICD codes, it’s important to have a solid grasp of their differences. Although both codes are crucial for effective communication among healthcare providers and facilities, keeping certain distinctions in mind is important. These include:
CPT Codes | ICD Codes | |
Purpose | ICD codes are used to identify medical diagnoses and necessities. | Medical procedures and services can be identified using CPT codes, which are mainly utilized for billing and reimbursements. |
Issuing Body | The American Medical Association (AMA) is responsible for maintaining the CPT codes, making them federal. | The World Health Organization (WHO) organizes the ICD codes, making them international. |
Versions and Updates | Interventions and procedures that happen during client interactions are referred to as CPT codes, and they are subject to frequent updates. The reason for this is the constant development of new treatments, and CPT codes must reflect precisely and accurately what occurred in every encounter. | ICD codes undergo revisions every ten to fifteen years, and the process is more challenging to regulate for international applications than for federal ones, resulting in a longer duration for the changes. The revisions made are generally substantial when the codes are revisited. |
Categorization | CPT codes are categorized based on the medical treatment and procedures administered. | ICD codes are categorized based on body systems or conditions. |
Simplicity | It's common to use multiple interventions or procedures during a client session, which can make CPT codes more intricate than ICD codes. Additionally, various codes and procedures may apply to the same disease or condition. | ICD codes are simpler because there is just one code for each condition and its diagnosis. |
Telehealth Encounters | ||
99201 – 99215 | Visits to a medical office or other outpatient setting. | New and established patients. |
G0425 – G0427 | These codes are used for telehealth consultations, emergency departments, or initial inpatients. | New and established patients |
Virtual Check-ins | ||
G2010 | As a healthcare provider, you can evaluate recorded video and/or images submitted by a patient who has already established care with you. This includes interpretation and follow-up with the patient within 24 business hours. However, this evaluation should not originate from a related E/M service provided within the previous seven days, nor should it lead to an E/M service or procedure within the next 24 hours or the soonest available appointment. | Established patient. |
G2012 | A quick chat between a medical professional and an established patient is conducted via technology, such as a virtual check-in. The medical professional will provide evaluation and management services, and the chat should not be related to any previous service provided within the past seven days, nor should it lead to any service or procedure within the next 24 hours or the soonest available appointment. The discussion should last 5-10 minutes and focus on medical topics. | Established patient. |
Practitioners who are unable to bill for E/M services can now bill for two newly created G codes that CMS has finalized. These codes, namely G2250 and G2251, are within the benefit categories of certain non-physician practitioners.
HCPCS G Code | ||
G2250 | An established patient can submit recorded videos and/or images for remote assessment (also known as store and forward). The provider will interpret the results and must provide follow-up within 24 hours. This service cannot be related to a service provided within the past seven days and cannot lead to a service or procedure within the next 24 hours or the soonest available appointment. | Established patient. |
G2251 | A short conversation via technology-based service between a trained healthcare provider and a patient who has already received care that does not include a formal medical evaluation or management and is not related to any recent or upcoming medical procedures or appointments. This discussion lasts for about 5 to 10 minutes. | Established patient. |
G2252 (Starting January 1, 2022, CMS implemented a new system that provides separate coding and payment for the extended virtual check-in service, documented under G2252.) | A medical professional can offer a short, technology-driven consultation service, such as a virtual check-in, to an existing patient. This service includes assessment and management services and lasts 11-20 minutes. It should not be related to an E/M service provided in the past week or lead to a procedure or E/M service in the next 24 hours or the next available appointment. The extended virtual check-in service payment has been cross-referenced to the reimbursement for the Current Procedural Terminology (CPT) code 99442. | Established patient. |
E-Visits | ||
99421 –99423 | An established patient can take advantage of an online digital evaluation and management service for up to 7 days. | Established patient. |
G2061 – G2063 | An evaluation conducted online by a certified healthcare expert who is not a physician. | Established patient. |
Telephone Services | ||
99441 –99443 | A physician or other qualified healthcare professional can conduct a phone assessment and management service for an existing patient, parent, or guardian. This service should be separate from an E/M service provided within the last week or lead to an E/M service or procedure within the next day or the next available appointment. | Established patient. |
The modifier 95 signifies a telemedicine service delivered synchronously through a real-time interactive audio and video telecommunications system.
Appendix P in the 2020 CPT® manual summarizes CPT codes that can be utilized for reporting synchronous (real-time) telemedicine services when appended by modifier 95.
The procedures listed in this summary involve electronic communication using interactive telecommunications equipment that includes, at the very least, audio and video.
HCPCS Level II Telehealth Codes | ||
G0406-G0408 | It can be utilized for follow-up consultations with inpatients using telehealth. | Established patient. |
G0425-G0427 | Telehealth consultation, emergency department. | New patient. |
G0508, G0509 | Telehealth consultation, critical care. | New and established patient. |
If you want reimbursement from an insurance company, you must provide certain ICD-10 codes for physical therapy. You can choose several codes that accurately depict the primary condition and its related symptoms, but only one code will be designated as the primary code.
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