1. Copyright © 2008 Delmar Learning. All rights reserved. Chapter 8 HCPCS Coding

2. Copyright © 2008 Delmar Learning. All rights reserved. 2 Introduction This chapter covers the coding reference developed by CMS –Healthcare Common Procedure Coding System (HCPCS)

3. Copyright © 2008 Delmar Learning. All rights reserved. 3 HCPCS There are two levels of HCPCS HCPCS level II –Introduced in 1983 after Medicare found that its payers used more than 100 different coding systems –This made it difficult to analyze claims data

4. Copyright © 2008 Delmar Learning. All rights reserved. 4 HCPCS Level I Includes the five digit CPT codes developed and published by the American Medical Association

5. Copyright © 2008 Delmar Learning. All rights reserved. 5 HCPCS Level II Describes common Medical services and supplies not classified in CPT Five characters in length –Begin with the letters A-V

6. Copyright © 2008 Delmar Learning. All rights reserved. 6 HCPCS Level II National Codes Contains a description –Codes are used primarily for billing purposes

7. Copyright © 2008 Delmar Learning. All rights reserved. 7 HCPCS Characteristics Ensures uniform reporting of medical products or services on claim forms Code descriptors identify similar products or services HCPCS is not a reimbursement methodology for making coverage or payment determinations

8. Copyright © 2008 Delmar Learning. All rights reserved. 8 Types of HCPCS Level II Codes Permanent national codes Dental codes Miscellaneous codes Temporary codes Modifiers

9. Copyright © 2008 Delmar Learning. All rights reserved. 9 Permanent National Codes Are maintained by the HCPCS national panel –Composed of representatives from the Blue Cross/Blue Shield Association, the Health Insurance Association of America, and CMS

10. Copyright © 2008 Delmar Learning. All rights reserved. 10 Dental Codes Contained in current dental terminology –Coding manual copyrighted and published by the American Dental Association that lists codes for billing for dental procedures and supplies

11. Copyright © 2008 Delmar Learning. All rights reserved. 11 Miscellaneous Codes Reported when a DMEPOS dealer submits a claim for a product or service for which there is no existing HCPCS Level II code

12. Copyright © 2008 Delmar Learning. All rights reserved. 12 Temporary Codes Are maintained by the CMS and other members of the HCPCS National Panel –Independent of permanent level II codes

13. Copyright © 2008 Delmar Learning. All rights reserved. 13 Categories of Temporary Codes G codes –Identify professional health care procedures and services that do not have codes identified in CPT

14. Copyright © 2008 Delmar Learning. All rights reserved. 14 Categories of Temporary Codes H codes –Reported to state Medicaid agencies that are mandated by state law to establish separate codes for identifying mental health services

15. Copyright © 2008 Delmar Learning. All rights reserved. 15 Categories of Temporary Codes K codes –Reported to MACs when existing permanent codes do not include codes needed to implement to MACs medical review coverage policy

16. Copyright © 2008 Delmar Learning. All rights reserved. 16 Categories of Temporary Codes Q codes –Identify services that would not ordinarily be assigned a CPT code

17. Copyright © 2008 Delmar Learning. All rights reserved. 17 Categories of Temporary Codes S codes –Used by BCBSA and the HIAA when no HCPCS Level II codes exist to report drugs, services, and supplies –Codes are needed to implement private payer policies and programs for claims processing

18. Copyright © 2008 Delmar Learning. All rights reserved. 18 Categories of Temporary Codes T codes –Reported to state Medicaid agencies when no HCPCS level II permanent codes exist But codes are needed to administer the Medicaid program

19. Copyright © 2008 Delmar Learning. All rights reserved. 19 Modifiers Provide additional information regarding the product or service identified –Either alphabetic or alphanumeric

20. Copyright © 2008 Delmar Learning. All rights reserved. 20 Assigning HCPCS Level II Codes Some services must be reported by assigning both HCPCS and CPT codes Most supplies are included in the charges for a visit