CODING FOR THE NON-CODERHCPCS LEVEL II – HCPCS CODES

SANDY SAGE R.N.

HCFA/CMS

• HCFA 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

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.

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.

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

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.

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

CMS

• CMS publishes an annual list of procedure to device edits on their website www.CMS.hhs.gov

• AHA Central Office is the only official clearinghouse for information on the proper use of HCPCS codes.

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.

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

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

J CODES

• Drugs that can not ordinarily be self administered.

• Chemotherapy drugs• Inhalation solutions• Other miscellaneous solutions

L CODES

• DME Durable Medical Equipment• Orthotic and prosthetic devices• Scoliosis equipment• Orthopedic Shoes• Prosthetic Implants

Q CODES• Temporary codes• Cast supplies• Drugs• LOCM/HOCM

• Q9967 – LOCM 300-399 mg/ml

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.

SCREENING CODES

• PSA• 84153 Prostate Specific Antigen• G0103 Prostate Cancer Screening,

prostate specific antigen

• Know the reason for the testing to understand what code is needed.

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.

REVIEW

SANDY SAGE R.N.Sandy.Sage@HCAhealthcare.com