HCPCS -- Healthcare Common Procedure Coding System

The HCPCS has two levels:

1. CPT (whose information is on the previous tab)
    
2. DMEPOS -- For "products, supplies, and services NOT included in the CPT codes, such as ambulance services and durable medical equipment, prosthetics, orthotics, and supplies (DMEPOS) when used outside a physician's office."
   --- This system was created to identify services, supplies, and equipment that are not included in the CPT but which *are* covered by Medicare and other insurers.
    

Here is the DMEPOS fee schedule that you can search

• Unlike the CPT and ICD, you *cannot* search this with keywords, but only with the DMEPOS code itself
• The easiest way to find those is by searching the open web, but look at more than one source to make sure you've found the correct code

HCUP (Healthcare Costs and Utilization Project) and HCUPnet
 

(To go directly to the HCUPnet database, scroll to the bottom.)

Background

• The Healthcare Cost and Utilization Project (HCUP) collects the data from "State data organizations, hospital associations, private data organizations, and the Federal government," and "includes the largest collection of longitudinal hospital care data in the United States," beginning in 1988. HCUP is run by the Agency for Healthcare Research and Quality (AHRQ).
   
• HCUPnet has databases of inpatient, ER, and ambulatory surgery statistics. These are estimates based on a sampling of data provided by each state. All 50 states participate in the inpatient sample, but the outpatient statistics are only provided by states representing about 2/3 of the U.S. population.
   
• HCUP data come in two types: The underlying datasets, which require some red tape and the use of statistical software such as SPSS; and HCUPnet, which is an online search tool providing immediate results. So always start with HCUPnet.

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UPDATE FREQUENCY: 
National statistics -- updated annually
State statistics -- updated as new state data are processed
Note: There is at least an 18-month lag between the end of the calendar year and the availability of the Nationwide Inpatient Sample (NIS)

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Tutorials:  Free, short, interactive tutorial is recommended; here are more tutorials)
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NOTE:  As of 2021, ICD-10 codes are no longer available *within* HCUPnet.

   -- Find ICD-10 codes from the WHO or the CDC

HCUP's statement:

"We apologize for the inconvenience...but the results may not be indicative of the intended clinical/surgical concept."

"Individual ICD-10-CM diagnoses or ICD-10-PCS procedures often need to be reported in combination to define a clinical/surgical concept, because of the specificity of the individual codes.

The ICD-10-CM Coding Guidelines provide a number of examples:
----Table of Contents of the Guidelines: pp.2-6; very helpful
----Section I: structure and conventions of the classification and general guidelines that apply to the entire classification, and chapter-specific guidelines that correspond to the chapters as they are arranged in the classification
----Section II: guidelines for selection of principal diagnosis for non-outpatient settings
----Section III: guidelines for reporting additional diagnoses in non-outpatient settings
----Section IV: for outpatient coding and reporting

• "HCUPnet does provide the ability to query clinical conditions and surgeries by the Clinical Classification Software Refined (CCSR), which aggregates ICD-10-CM/PCS into clinically meaningful categories, for the HCUP National Inpatient Sample (NIS) data and Nationwide Emergency Department Sample (NEDS) data.
  

• "As an alternative, frequencies of ICD-10-CM/PCS codes (individually and by the CCSR categories) will be available in the Documentation section of each nationwide database on the HCUP User Support website. Currently, the frequencies of ICD-10-CM/PCS codes reported in the HCUP NIS are available at https://hcup-us.ahrq.gov/db/nation/nis/nisdbdocumentation.jsp.

• "For any HCUP database, tool, or product-related questions, please visit the HCUP FAQ page at www.hcup-us.ahrq.gov/tech_assist/faq.jsp or contact User Support at hcup@ahrq.gov."

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HCUPnet -- The Database Itself)
 

1. Go to the HCUPnet page
2. "Inpatient" will get you the most information
3. NOTE:  The numbers in "Emergency Department" and in "Ambulatory Surgery" only represent patients from about 2/3 of U.S. hospitals. Therefore, multiply the numbers you get by 3/2.
4. Note: "Trends" has data only through 2014 (and uses ICD-9).
5. When you're done, create analysis. Understanding the results can be difficult sometimes.

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Refining Your Results

The blue navigation bar on the left includes several ways to focus your results, including:

• results by patient or hospital characteristics
• settings of care, geography, and year of analysis
• all-listed vs. principal diagnosis or procedure (remember that principle will not include patients who had the diagnosis as a secondary or tertiary problem, so think about whether you want ONLY that main diagnosis, or ALL patients who had it, no matter what else they had).

Your results can also be graphed and exported (click SUBMIT at the bottom to make your changes).

Note: Some selections on the blue navigation bar might be greyed out; this could be because of the database type, data year (after 2015, when ICD-10-CM/PCS codes were introduced); principal versus all-listed diagnosis (procedure); or other reason. 

To clear your selections, either go back to the home page (this will clear everything), or change your selections on the blue navigation bar, and click SUBMIT again.

ICF -- International Classification of Functioning, Disability, and Health
 

This classification was created by the World Health Organization (WHO) and approved in 2001.

Its purpose is to provide a "framework for measuring health and disability at both individual and population levels."

The WHO page about the ICF includes:

• an overview of the classification, written by the CDC
• an easy way to browse the sections online

(Remember that this framework is only one piece of a complicated landscape!)

For more codes and information, see the Reimbursement Toolkit page of the Health Care Reimbursement guide.