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Overview: Procedure codes are documented in the electronic medical records using several standardized coding systems, which are reviewed in further detail below. Each procedure code is associated with the encounter in which the procedure took place.

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Note

Although CPT-4 and HCPCS procedure codes are available in i2b2, note that Keck Care sites most often utilize the ICD procedure coding system. We strongly recommend using ICD codes in your query, either in addition to or in lieu of CPT/HCPCS codes.

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ACT Procedures ICD-9-Proc

  • Description: Procedures based on the International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM)

  • Dates: ICD-9 codes were used at Keck Medicine care sites up until October 2015. After this date, we transitioned to using the ICD-10 coding system. Keep this in mind when running queries. If you would like to search for patients that underwent a procedure after October 2015, you must include the corresponding ICD-10 code in your query.

  • For more information, visit the following page: https://www.cdc.gov/nchs/icd/icd9cm.htm

ACT Procedures ICD-10-PCS

  • Description: Procedures based on the International Classification of Diseases, Tenth Revision (ICD-10)

  • Dates: October 2015 to present. Prior to October 2015, Keck Medicine care sites used the ICD-9 coding system. Keep this in mind when you are running queries. If you would like to search for patients that underwent a procedure prior to October 2015, you must include the corresponding ICD-9 code in your query.

  • For more information, visit the following page: https://www.cdc.gov/nchs/icd/icd-10-cm.htm

ACT Procedures CPT-4

  • Description: Procedures based on the Current Procedural Terminology (CPT®) system, developed by the American Medical Association (AMA).

  • Dates: 2009 to present

  • For more information, visit the following page: https://www.ama-assn.org/practice-management/cpt

ACT Procedures HCPCS

  • Description: Procedures based on the Healthcare Common Procedure Coding System (HCPCS), which was created by the Centers for Medicare & Medicaid Services (CMS)

  • Dates: 2011 to present

  • For more information, visit the following page: https://www.cms.gov/Medicare/Coding/MedHCPCSGenInfo

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