The goal of this repository is to help developers in their work with ICD/HCPCS and other coding schemes.

CPT Category II (CDM - C2)

Category II codes are supplemental tracking codes that are intended to be used for performance measurement. In compliance with ongoing changes being made because of HIPAA regulations, these codes provide a method for reporting performance measures. The Category II codes are intended to facilitate the collection of information about the quality of care delivered by coding a number of services or test results that support performance measures. These performance measures have been agreed upon as contributing to good patient care.

The Category II Codes are alphanumeric and consist of four digits followed by the alpha character 'F.' The use of these codes is optional and are not a substitute for Category I codes.

CPT Category II codes will be arranged according to the following categories:

Composite Measures 0001F
Patient Management 0500F-0503F
Patient History 1000F-1002F
Physical Examination 2000F
Diagnostic/Screening Processes or Results 3000F
Therapeutic, Preventive or Other Interventions 4000F-4011F
Follow-up or Other Outcomes 5000F
Patient Safety 6000F

CPT Category III (CDM - C3)

Category III codes represent temporary codes for new and emerging technologies. They have been created to allow for data collection and utilization tracking for new procedures or services. Category III codes are different from Category I CPT codes in that they identify services that may not be performed by many health care professionals across the country, do not have FDA approval, nor does the service/procedure have proven clinical efficacy. To be eligible for a Category III code, the procedure or service must be involved in ongoing or planned research. The rationale behind these codes is to help researchers track emerging technology and services to substantiate widespread usage and clinical efficacy. In the past, researchers have been hindered by the length and requirements of the current CPT approval process.

The Category III codes are five characters long, with four digits followed by the letter 'T' in the last field (e.g. 0002T). The codes are intended to be temporary and will be retired if the procedure or service is not accepted as a Category I code within five years. In some instances Category III codes may replace temporary local codes (HCPCS Level III) assigned by carriers and intermediaries to describe new procedures or services. If a Category III code is available it must be used instead of the unlisted Category I code. The use of the unlisted code does not offer the opportunity for collection of specific data.

HCPCS Level I (CDM - C4, aka CPT-4, aka CPT Category I)

CPT-4 codes (5 digits) are copyrighted by AMA -- a license is needed for usage.

Note: you can download the current_lmrp.zip file and extract the hcpc_code_lookup.csv file to lookup codes.

HCPCS Level III (CDM - H3)

From wikipedia:

HCPCS-L3 cdes, also called local codes, were developed by state Medicaid agencies, Medicare contractors, and private insurers for use in specific programs and jurisdictions. The Health Insurance Portability and Accountability Act of 1996 (HIPAA) instructed CMS to adopt a standard coding systems for reporting medical transactions. The use of Level III codes was discontinued on December 31, 2003, in order to adhere to consistent coding standards.

Alpha-Numeric HCPCS Level II (CDM - HC)

From www.cms.gov the following archive was downloaded: 2016 Alpha-Numeric HCPCS File (ZIP, 978KB)

It contains the following files:

@see https://en.wikipedia.org/wiki/HCPCS_Level_2

HCPCS modifiers

From www.codingahead.com:

Modifier - as the name implies a modifier will modify a service / procedure or an item under certain circumstances for appropriate reimbursement. Modifiers may add information or change the description according to the physician documentation to give more specificity for the service or procedure rendered. Appending of an appropriate modifier will effectively respond to reimbursement.

Level I Modifiers: Normally known as CPT Modifiers and consists of two numeric digits and are updated annually by AMA - American Medical Association.
Level II Modifiers: Normally known as HCPCS Modifiers and consists of two digits (Alpha / Alphanumeric characters) in the sequence AA through VP.

These modifiers are annually updated by CMS (Center for Medicare and Medicaid Services)

ICD-9-CM

Diagnosis and Procedure Codes: Abbreviated and Full Code Titles

From the www.cms.gov the following archive was downloaded: ICD-9-CM-v32-master-descriptions.zip

It contains the following files:

Notes:

DX stands for Diagnosis
SG stands for Procedures

ICD-10

There are two types: CM (diagnosis) and PCS (procedures)

ICD-10-CM (Clinical Modification - are these used in CDM?)

ICD-10-PCS (Procedure Coding System)

From the www.cms.gov the following archives have been downloaded:

ufbmi/icd-tools