Loss less coding is an important technique that it will efficiently compress valuable information without any loss. This technique plays an important role for the medical applications that the content cannot allow any distortions. Recently, the advance video coding (H.264/AVC), which is well known to provide high compression ratio has been applied to loss less coding system. In this paper, we proposed a hierarchical loss less video coding structure based on H.264/AVC to improve the compression ratio. The base layer is the H.264/AVC lossy coding system, and the enhancement layer is the loss less entropy coding system used to encode the error that made by DCT and quantization. Moreover, to improve the coding efficiency we also proposed a new intra prediction process to replace the sample-by-sample DPCM concept. The simulation results show that the proposed methods have better performance than DPCM-Based H.264/AVC loss less coding system.