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CODING FOR THE NON-CODER HCPCS LEVEL II – HCPCS CODES SANDY SAGE R.N.

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Presentation on theme: "CODING FOR THE NON-CODER HCPCS LEVEL II – HCPCS CODES SANDY SAGE R.N."— Presentation transcript:

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2 CODING FOR THE NON-CODER HCPCS LEVEL II – HCPCS CODES SANDY SAGE R.N.

3 HCFA/CMS HCFA developed the original version of the HCPCS coding system in Designed to represent services provided to Social Security beneficiaries under the Federal Medicare program. Implemented in 1985

4 PURPOSE To fulfill the operational needs of the Medicare reimbursement system. Enables providers and suppliers to accurately communicate information about the services and supplies provided. Data analysis is used to establish financial controls to prevent expense escalation.

5 LEVEL II – HCPCS CODES Alpha-numeric coding system for healthcare providers and medical suppliers to report certain drugs, medical supplies and DME. Maintained by CMS and the HCPCS National Panel comprised of several large medical insurers.

6 LEVEL II – NATIONAL CODES One letter and 4 numbers A-codes: Medical Supplies C-codes: OPPS codes E-codes: DME G and K-codes: Temporary codes J-codes: Drug codes L-codes: Orthotics and Prosthetics

7 DEVICE CODES = C CODES Effective January 1, 2005 CMS mandated that OPPS hospitals that report procedure codes requiring the use of devices must also report the applicable HCPCS codes and charges for all devices used to perform the procedure.

8 DEVICE CODES To avoid payment denial claims must have accurate device codes that match the procedure that was performed. Coding, charging and billing issue. Coding and billing edits Review of documentation Review of charging processes

9 CMS CMS publishes an annual list of procedure to device edits on their website AHA Central Office is the only official clearinghouse for information on the proper use of HCPCS codes.

10 C-CODES C-codes are only reported for facility (technical) services. Includes device categories, new technology, drugs and biologicals that do not have another code assigned. May be eligible for OPPS pass-through payment.

11 C-CODE EXAMPLES C1713 – Anchor or screw for bone to bone implantable. C1898 – Lead, Pacemaker C2627 – Catheter Suprapubic C8918 – MRA with contrast pelvis C9245 – Injection, clevidipine butyrate 1 mg

12 E CODES Only used by licensed DME providers E0110 – Crutches, forearm E0130 – Walker, rigid E0607 – Home blood glucose monitor E1229 – Wheelchair, pediatric Not brand specific

13 J CODES Drugs that can not ordinarily be self administered. Chemotherapy drugs Inhalation solutions Other miscellaneous solutions

14 L CODES DME Durable Medical Equipment Orthotic and prosthetic devices Scoliosis equipment Orthopedic Shoes Prosthetic Implants

15 Q CODES Temporary codes Cast supplies Drugs LOCM/HOCM Q9967 – LOCM mg/ml

16 CODING STANDARDS Levels of use: When a CPT and HCPCS level II code have virtually identical narratives for a procedure or service the CPT code should be used. If the HCPCS code narrative is more specific the Level II code should be used.

17 SCREENING CODES PSA Prostate Specific Antigen G0103 Prostate Cancer Screening, prostate specific antigen Know the reason for the testing to understand what code is needed.

18 LEVEL II MODIFIERS Used in the same way and for the same reason that Level I modifiers are used. Used to clarify the services being billed. Add more information. Eliminate the appearance of duplicate billing and unbundling.

19 REVIEW

20 SANDY SAGE R.N.


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