Presentation on theme: "CODING FOR THE NON-CODER HCPCS LEVEL II – HCPCS CODES"— Presentation transcript:
1 CODING FOR THE NON-CODER HCPCS LEVEL II – HCPCS CODES SANDY SAGE R.N.This is section three of coding for the non-coder. In this section we will be reviewing and learning about level II HCPCS codes.
2 HCFA/CMSHCFA developed the original version of the HCPCS coding system in 1983.Designed to represent services provided to Social Security beneficiaries under the Federal Medicare program.Implemented in 1985(SLIDE)
3 PURPOSETo 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.The purpose of the creation of HCPCS codes was to fulfill the operational needs of the Medicare reimbursement system. Use of these codes enables providers and suppliers to accurately communicate information about the supplies and services provided. Data analysis by CMS is used to establish financial controls to prevent escalation of expenses in the Medicare program.
4 LEVEL II – HCPCS CODESAlpha-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.Level II HCPCS codes are an alphanumeric coding system for healthcare providers and medical suppliers to report certain drugs, medical supplies and DME. Level II codes are maintained by CMS and a HCPCS National panel that is composed of several large insurers.
5 LEVEL II – NATIONAL CODES One letter and 4 numbersA-codes: Medical SuppliesC-codes: OPPS codesE-codes: DMEG and K-codes: Temporary codesJ-codes: Drug codesL-codes: Orthotics and ProstheticsHCPCS codes are national codes that are comprised on one letter at the beginning and then 4 numbers. Each letter designates a category. So all codes beginning with the letter A you know are medical supply codes. C codes are codes paid under OPPS> E codes are your DME codes. G and K codes are usually temporary codes that are awaiting a permanent CPT code assignment or they may only be temporarily paid by Medicare. J codes are drug codes and L codes designate orthotics and prosthetics. There are more categories and letters that can be found in your HCPCS book.
6 DEVICE CODES = C CODESEffective 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.(SLIDE) For instance if a pacemaker procedure is charged then the pacemaker supply must be billed as well. The pacemaker itself is assigned a C code. If for some reason the insertion is charged and the pacemaker itself is not then the claim will be returned to provider for correction.
7 DEVICE CODESTo avoid payment denial claims must have accurate device codes that match the procedure that was performed.Coding, charging and billing issue.Coding and billing editsReview of documentationReview of charging processesSo we want to avoid payment denials and delays so it is important that devices are billed with the procedures that are coded. If your bills are incorrect you have to find out if you have a coding, charging or billing issue to resolve. Hopefully you have coding and billing edits in place to catch these before they are transmitted so they can be corrected on the front end. Depending on the issues you find you may have to do some process reviews at your facility.
8 CMSCMS publishes an annual list of procedure to device edits on their websiteAHA Central Office is the only official clearinghouse for information on the proper use of HCPCS codes.(SLIDE)
9 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.So we discussed that C codes are device codes. They are only reported for facility technical services. That would include not only the devices but some drugs and biologicals that do not have another code assigned. As usual there are exceptions to every rule and some categories may overlap. C codes may also be eligible for OPPS pass through payment when reported.
10 C-CODE EXAMPLES C1713 – Anchor or screw for bone to bone implantable. C1898 – Lead, PacemakerC2627 – Catheter SuprapubicC8918 – MRA with contrast pelvisC9245 – Injection, clevidipine butyrate 1 mgHere are some examples: (SLIDE) So you can see that the MRA and the injectable drug would be exceptions to the device category. However the C codes are usually device codes.
11 E CODES Only used by licensed DME providers E0110 – Crutches, forearm E0130 – Walker, rigidE0607 – Home blood glucose monitorE1229 – Wheelchair, pediatricNot brand specificE codes are only to be used by licensed DME providers for their billing. They re not brand specific just product specific like these listed.
12 J CODES Drugs that can not ordinarily be self administered. Chemotherapy drugsInhalation solutionsOther miscellaneous solutionsJ codes are drugs that can not ordinarily be self administered. That includes chemotherapy drugs, inhalation solutions and other miscellaneous drug solutions.
13 L CODES DME Durable Medical Equipment Orthotic and prosthetic devices Scoliosis equipmentOrthopedic ShoesProsthetic Implants(SLIDE)
14 Q CODES Temporary codes Cast supplies Drugs LOCM/HOCM Q9967 – LOCM mg/mlQ codes are usually temporary codes that are awaiting CPT code assignment. They may also be cast supplies, and some drugs most commonly are the low and high osmolar contrast drugs used primarily in radiology procedures.
15 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.
16 SCREENING CODES PSA 84153 Prostate Specific Antigen G Prostate Cancer Screening, prostate specific antigenKnow the reason for the testing to understand what code is needed.
17 LEVEL II MODIFIERSUsed 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.