1. Procedural Coding: Introduction to HCPCS Chapter 6
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2. Learning Outcomes After studying this chapter, you should be able to:
6.1 Discuss the purpose of the HCPCS code set.
6.2 Explain how to locate the periodic updates to HCPCS codes.
6.3 Describe the structure and content of the index, the Table of Drugs, and the main text in HCPCS.
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3. Learning Outcomes (Continued)
6.4 Describe the purpose and correct use of HCPCS modifiers.
6.5 List the steps for assigning correct HCPCS codes and modifiers.
6.6 Discuss the tools used to verify billing rules for specific HCPCS codes.
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4. Key Terms CMS HCPCS Workgroup Coverage Issues Manual (CIM)
Durable medical equipment (DME)
Durable medical equipment, prosthetics, orthotics, and supplies (DMEPOS)
Durable Medical Equipment Regional Carrier (DMERC)
Healthcare Common Procedure Coding System (HCPCS)
Level II
Level II modifiers
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5. Key Terms (Continued) Medicare Carriers Manual (MCM)
Permanent national codes
Statistical analysis durable medical equipment carrier (SADMERC)
Temporary national codes
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6. Overview of HCPCS H Healthcare C Common P Procedure C Coding S System
Medical procedures, products, services not in CPT
Mandated HIPAA code set
Maintained by CMS
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7. Level II Codes Five characters: Letter and four numbers
Tabular list contains sections for each type of service
Often code durable medical equipment (DME), supplies, drugs, and services/procedures not in CPT level I such as transportation, orthotics/prosthetics, and vision/hearing services, as well as a large section of temporary codes
New services are assigned temporary CMS or national codes released quarterly
Permanent codes updated annually
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8. HCPCS Coding Procedures
Coding Steps:
Look up item in the index
Verify code selection using the Tabular List
Report quantities carefully—the code must match the route and the dose
Assign Level II modifiers as appropriate
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9. HCPCS Billing Procedures
Billing Medicare
Review symbols for:
Not covered by or valid for Medicare
Special coverage instructions apply
Carrier discretion
And then review Medicare rules:
Medicare Carriers Manual (MCM)
Coverage Issues Manual (CIM)
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