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In the MEDICAL_SERVICE_LINES table, there is a field ‘PROCEDURE’. The data dictionary notes that this is ‘CPT, HCPCS, or ICD-10-PCS (less commonly)’. Is there a field that indicates which of these terminologies the code is from?

Can you use modifiers to help identify? Or are the code formats the best tool like: CPT: 5 numbers or 4 numbers and a letter (in that order) HCPCS: 1 letter and 4 numbers (in that order).

This customer receives PLAID and is not in Sentinel. (data dictionary here)

user19603548
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1 Answers1

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The code formats would be the best to distinguish definitively what type of code it is. The modifiers are not filled out all the time (some claims may not have modifiers attached to the procedure).

Your layout of the code format is correct (see section HCPCS Coding here for additional confirmation). HCPCS Level 1 is comprised of CPT codes. HCPCS Level 2/3 is what we typically regard as just "HCPCS"

Vicki Guan
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