1. Copyright © 2016 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education. 15-1 Chapter 15 CODING MEDICAL SUPPLIES, DURABLE MEDICAL EQUIPMENT, PHARMACEUTICAL, AND AMBULANCE AND OTHER TRANSPORTATION SERVICES

2. Copyright © 2016 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education. Learning Objectives 15.1 Interpret correctly the rules and guidelines for coding medical supplies. 15.2 Apply the instructions for properly coding durable medical equipment. 15.3 Report the accurate codes for pharmaceutical services. 15-2

3. Copyright © 2016 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education. Learning Objectives (cont.) 15.4 Distinguish between the generic and brand names of drugs. 15.5 Utilize the guidelines for coding transportation services. 15.6 Calculate correct waiting time for transportation services. 15-3

4. Copyright © 2016 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education. Key Terms Advanced life support (ALS) Basic life support (BLS) Cannula Decubitus ulcer DMEPOS 15-4

5. Copyright © 2016 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education. Key Terms (cont.) Incontinence Ostomy Self-administer Specialty care transport (SCT) Transcutaneous electrical nerve stimulators (TENS) 15-5

6. Copyright © 2016 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education. Introduction HCPCS Level II codes include Medical supplies Durable medical equipment (DME) Pharmaceuticals Transportation services 15-6

7. Copyright © 2016 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education. Coding Medical Supplies Given to a patient to self- administer healthcare at home 15-7

8. Copyright © 2016 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education. A Codes and B Codes Miscellaneous Supplies A4206– A4290 –Supplies used in the course of treatment Syringes, alcohol wipes, urine test strips 15-8

9. Copyright © 2016 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education. A Codes and B Codes (cont.) Miscellaneous Supplies A4206– A4290 –Supplies provided to patients for use at home Diabetic patient needing daily insulin at home must have syringes 15-9

10. Copyright © 2016 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education. A Codes and B Codes (cont.) Vascular Catheters A4300–A4306 –Report the use of a disposable drug delivery system (DDS) –Code not for reporting physician’s work to implant catheter 15-10

11. Copyright © 2016 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education. A Codes and B Codes (cont.) Incontinence Appliances and Care Supplies A4310–A4355 External Urinary Supplies A4356– A4360 –For patients diagnosed with permanent or chronic incontinence 15-11

12. Copyright © 2016 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education. A Codes and B Codes (cont.) Ostomy Supplies A4361–A4434 –For patients who need supplies every day to assist in their medical situation 15-12

13. Copyright © 2016 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education. A Codes and B Codes (cont.) Additional Miscellaneous Supplies A4450–A4608 –Grouping of codes for other necessary items 15-13

14. Copyright © 2016 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education. A Codes and B Codes (cont.) Supplies for Oxygen and Related Respiratory Equipment A4611– A4629 Supplies for Other Durable Medical Equipment A4630–A4640 –Ancillary supplies and items used in conjunction with DME –Cannula or cleaning brush 15-14

15. Copyright © 2016 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education. A Codes and B Codes (cont.) Supplies for Radiologic Procedures A4641–A4932 –Ancillary items needed during and/or after radiologic procedures 15-15

16. Copyright © 2016 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education. A Codes and B Codes (cont.) Additional Ostomy Supplies A5051– A5093 Additional Incontinence Appliances/Supplies A5102–A5114 Supplies for Either Incontinence or Ostomy Appliances A5120–A5200 –Additional codes for items needed by patients with medical problems 15-16

17. Copyright © 2016 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education. A Codes and B Codes (cont.) Diabetic Shoes, Fitting, and Modifications A5500–A5511 –For diabetics only –Each code specifies coverage of only one shoe –For a pair of shoes, report twice 15-17

18. Copyright © 2016 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education. A Codes and B Codes (cont.) Dressings A6000–A8004 –Wound care supplies Bandages 15-18

19. Copyright © 2016 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education. A Codes and B Codes (cont.) Administrative, Miscellaneous, and Investigational A9000–A9999 –Catch-all items –Nonprescription medications, exercise equipment, and other supplies provided for home care 15-19

20. Copyright © 2016 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education. A Codes and B Codes (cont.) Enteral Formulae and Enteral Medical Supplies B4034–B4162 Parenteral Nutrition Solutions and Supplies B4164–B5200 15-20

21. Copyright © 2016 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education. A Codes and B Codes (cont.) Enteral and Parenteral Pumps B9000–B9999 –Supply of items related to providing nutrition by alternate means, other than by mouth and/or the digestive tract 15-21

22. Copyright © 2016 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education. Coding Durable Medical Equipment (DME) Functional innovations Canes, walkers, and wheelchairs Portable oxygen Healthcare facility should be reimbursed for giving equipment 15-22

23. Copyright © 2016 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education. Coding Durable Medical Equipment (DME) (cont.) Durable Medical Equipment –Can withstand repeated use –Is primarily used for medical purposes –Is used in the patient’s home (rather than only in a healthcare facility) 15-23

24. Copyright © 2016 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education. Coding Durable Medical Equipment (DME) (cont.) Durable Medical Equipment (cont.) –Would not be used if the individual were not ill or injured –DMEPOS dealers supply DME to the patient –Submit claims to assigned durable medical equipment regional carrier (DMERC) 15-24

25. Copyright © 2016 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education. Coding Durable Medical Equipment (DME) (cont.) HCPCS E Code Subheadings –E0100–E9999 –Dedicated to DME services and supplies –Canes, crutches, walkers, wheelchairs, etc. 15-25

26. Copyright © 2016 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education. Coding Pharmaceutical Services Methods of Administering Drugs –IA Intra-arterial administration –IV Intravenous administration (e.g., gravity infusion, injections, and timed pushes) –IM Intramuscular administration –IT Intrathecal 15-26

27. Copyright © 2016 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education. Coding Pharmaceutical Services (cont.) Methods of Administering Drugs (cont.) –SC Subcutaneous administration –INH Inhaled solutions –VAR Various routes for drugs that are commonly administered into joints, cavities, tissues, or topical applications, as well as other parenteral administrations 15-27

28. Copyright © 2016 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education. Coding Pharmaceutical Services (cont.) Methods of Administering Drugs (cont.) –ORAL Administered orally –OTH Other routes of administration, such as suppositories or catheter injections 15-28

29. Copyright © 2016 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education. Generic Names and Brand Names Drugs listed by chemical or generic name When notes describe a brand name or trade name of drug, use the following: –Alphabetic index of the HCPCS Level II book. Some—but not all—drugs are shown in the alphabetic index by both the generic name and a brand, or trade, name. 15-29

30. Copyright © 2016 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education. Generic Names and Brand Names (cont.) When notes describe a brand name or trade name of drug, use the following: –Appendix 1, Table of Drugs, of the HCPCS Level II book –Physicians’ Desk Reference (PDR) 15-30

31. Copyright © 2016 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education. Generic Names and Brand Names (cont.) Appendix 1—Table of Drugs –Lists drugs by generic x and/or brand names alphabetically Column one lists drug names in alphabetical order Column two identifies the most often-used unit measurement or dose Column three indicates method of administration Column four has suggested codes 15-31

32. Copyright © 2016 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education. Generic Names and Brand Names (cont.) Double check code in the alphanumeric listing. 15-32

33. Copyright © 2016 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education. Generic Names and Brand Names (cont.) Notations –Some code descriptions include additional names, usually brand names, also represented by that code to confirm a generic drug and a brand name drug reported with the same code 15-33

34. Copyright © 2016 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education. Generic Names and Brand Names (cont.) Quantity Specifications –Many codes also include the measurement of a typical dose in the code’s description 15-34

35. Copyright © 2016 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education. Generic Names and Brand Names (cont.) Measurement Equivalents 15-35

36. Copyright © 2016 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education. Generic Names and Brand Names (cont.) J Codes –J0000–J9999 –Used for reporting drugs administered by healthcare professionals –Cannot be self-administered 15-36

37. Copyright © 2016 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education. Coding Ambulance and Other Transportation Services A0000–A0999 –Ground ambulances –Air ambulances (often a helicopter but not exclusively) 15-37

38. Copyright © 2016 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education. Coding Ambulance and Other Transportation Services (cont.) A0000–A0999 –Nonemergency transportation, such as a special van, taxi cab, car, or bus –Additional or secondary related costs and fees 15-38

39. Copyright © 2016 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education. Coding Ambulance and Other Transportation Services (cont.) Coding Components –What type of vehicle was used to transport the patient? Ground (ambulance, taxi, bus, minibus, van, etc.) Air—fixed wing (such as an airplane) Air—rotary wing (such as a helicopter) 15-39

40. Copyright © 2016 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education. Coding Ambulance and Other Transportation Services (cont.) Coding Components (cont.) –What type of services did the patient need? Emergency Nonemergency Advanced life support (ALS) Basic life support (BLS) Specialty care transport (SCT) 15-40

41. Copyright © 2016 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education. Coding Ambulance and Other Transportation Services (cont.) Coding Components (cont.) –Did the ambulance have to wait? 15-41

42. Copyright © 2016 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education. Coding Ambulance and Other Transportation Services (cont.) Coding Components (cont.) –How many miles did the ambulance have to travel from origin to destination? –Were extra personnel required? 15-42

43. Copyright © 2016 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education. Coding Ambulance and Other Transportation Services (cont.) Transportation Codes in Other Sections –S series (S0000–S9999) Temporary codes Not accepted by Medicare –T codes (T1000–T9999) Used by Medicaid state agencies 15-43

44. Copyright © 2016 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education. Coding Ambulance and Other Transportation Services (cont.) Ambulance Origin/Destination –Origin of service –Destination of service 15-44

45. Copyright © 2016 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education. Transportation Waiting Time Waiting time is measured in units of 30 minutes or less Not reported until the transportation vehicle has been waiting for 31 minutes or more 15-45

46. Copyright © 2016 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education. Transportation Waiting Time (cont.) Ambulance billing indicators –Two-character alphanumeric modifier –Used to supply information regarding the patient’s condition, reason for the transport and level of services provided during transport 15-46

47. Copyright © 2016 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education. Transportation Waiting Time (cont.) 15-47

48. Copyright © 2016 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education. Chapter Summary Understanding the complexities of HCPCS Level II codes opens many opportunities for employment, from skilled nursing facilities to durable medical equipment suppliers. 15-48