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Live or Die by the Guidelines:

HCPCS Level II

Common Procedural Terminology (CPT®) codes, descriptions, and material only are Copyright © 2013 American Medical Association (AMA).

All Rights Reserved. No fee schedules, basic units, relative values, or related listings are included in CPT. The AMA assumes no liability for the data contained herein. Applicable FARS/DFARS restrictions apply to government use.

CPT is a registered trademark of the American Medical Association.

AMA Disclaimer

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• Be alert to confusion over term “HCPCS”

• Understand the variety of goods and services that can be reported with HCPCS Level II codes

• Review concepts on when HCPCS Level II codes are appropriate

• See importance of teaching HCPCS to your students

Goals

• Healthcare Common Procedural Coding System

– This designation comes from CMS, and

encompasses:

• HCPCS Level I, national CPT® codes

• HCPCS Level II, supplemental codes for supplies and

procedures

• HCPCS Level III, defunct local coding system

HCPCS

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• Before pursuing a HCPCS Level II code, ask, “Is

this a routine supply?”

– Routine supply is not reported

– Nonroutine supply is reported

• Also ask, “Is the place of service appropriate for

HCPCS Level II code reporting?”

HCPCS – Level II

• HCPCS Level II created by CMS

– But that doesn’t mean all codes are covered

• Some are never covered, by statutory law

• Some coverage is determined locally

HCPCS – Level II

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• Alpha-numeric

• Report supplies as well as, services not included in CPT®

• New HCPCS codes are evaluated in public hearings held in Baltimore

– http://www.cms.gov/MedHCPCSGenInfo/08_HCPCSPublicMeetings.asp

• Updated continually, although most updates are implemented January 1

HCPCS – Level II

• Permanent codes

– Report supplies or services that would never be

issued a CPT® code

• Temporary codes

– Meet, within a short time, the need for a national code

• May be retained over time

• May be replaced by a CPT® code

HCPCS – Level II

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• Temporary codes

– C codes for HOPPS

– G codes for procedures not in CPT® (for example, PQRI codes)

– K codes for temporary DME

– Q codes for drugs and biologicals that haven’t been assigned permanent codes

– S codes for private sectors’ reporting requirements

– T codes for Medicaid agencies

HCPCS – Level II

http://www.cms.gov/HCPCSReleaseCodeSets/ANHCPCS/list.asp

• www.cms.gov

• Medicare

• Coding

• HCPCS Release & Code Sets

HCPCS Level II Information

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HCPC Seq Num RIC Long Description Short Description

G0008 00100 3 ADMINISTRATION OF INFLUENZA VIRUS VACCINE Admin influenza virus vac

G0009 00100 3 ADMINISTRATION OF PNEUMOCOCCAL VACCINE Admin pneumococcal vaccine

G0010 00100 3 ADMINISTRATION OF HEPATITIS B VACCINE Admin hepatitis b vaccine

G0027 00100 3 SEMEN ANALYSIS; PRESENCE AND/OR MOTILITY OF SPERM EXCLUDING HUHNER Semen analysis

G0030 00100 3 PET MYOCARDIAL PERFUSION IMAGING, (FOLLOWING PREVIOUS PET, G0030-G0047); SINGLE PET imaging prev PET single

G0030 00200 4 STUDY, REST OR STRESS (EXERCISE AND/OR PHARMACOLOGIC)

G0031 00100 3 PET MYOCARDIAL PERFUSION IMAGING, (FOLLOWING PREVIOUS PET, G0030-G0047); PET imaging prev PET multple

G0031 00200 4 MULTIPLE STUDIES, REST OR STRESS (EXERCISE AND/OR PHARMACOLOGIC)

G0032 00100 3 PET MYOCARDIAL PERFUSION IMAGING, (FOLLOWING REST SPECT, 78464); SINGLE STUDY, PET follow SPECT 78464 singl

G0032 00200 4 REST OR STRESS (EXERCISE AND/OR PHARMACOLOGIC)

G0033 00100 3 PET MYOCARDIAL PERFUSION IMAGING, (FOLLOWING REST SPECT, 78464); MULTIPLE PET follow SPECT 78464 mult

G0033 00200 4 STUDIES, REST OR STRESS (EXERCISE AND/OR PHARMACOLOGIC)

G0034 00100 3 PET MYOCARDIAL PERFUSION IMAGING, (FOLLOWING STRESS SPECT, 78465); SINGLE PET follow SPECT 76865 singl

G0034 00200 4 STUDY, REST OR STRESS (EXERCISE AND/OR PHARMACOLOGIC)

G0035 00100 3 PET MYOCARDIAL PERFUSION IMAGING, (FOLLOWING STRESS SPECT, 78465); MULTIPLE PET follow SPECT 78465 mult

G0035 00200 4 STUDIES, REST OR STRESS (EXERCISE AND/OR PHARMACOLOGIC)

G0036 00100 3 PET MYOCARDIAL PERFUSION IMAGING, (FOLLOWING CORONARY ANGIOGRAPHY, PET follow cornry angio sing

G0036 00200 4 93510-93529); SINGLE STUDY, REST OR STRESS (EXERCISE AND/OR PHARMACOLOGIC)

G0037 00100 3 PET MYOCARDIAL PERFUSION IMAGING, (FOLLOWING CORONARY ANGIOGRAPHY, PET follow cornry angio mult

G0037 00200 4 93510-93529); MULTIPLE STUDIES, REST OR STRESS (EXERCISE AND/OR PHARMACOLOGIC)

G0038 00100 3 PET MYOCARDIAL PERFUSION IMAGING, (FOLLOWING STRESS PLANAR MYOCARDIAL PET follow myocard perf sing

G0038 00200 4 PERFUSION, 78460); SINGLE STUDY, REST OR STRESS (EXERCISE AND/OR PHARMACOLOGIC)

G0039 00100 3 PET MYOCARDIAL PERFUSION IMAGING, (FOLLOWING STRESS PLANAR MYOCARDIAL PET follow myocard perf mult

G0039 00200 4 PERFUSION, 78460); MULTIPLE STUDIES, REST OR STRESS (EXERCISE AND/OR

G0039 00300 4 PHARMACOLOGIC)

G0040 00100 3 PET MYOCARDIAL PERFUSION IMAGING, (FOLLOWING STRESS ECHOCARDIOGRAM, 93350); PET follow stress echo singl

G0040 00200 4 SINGLE STUDY, REST OR STRESS (EXERCISE AND/OR PHARMACOLOGIC)

G0041 00100 3 PET MYOCARDIAL PERFUSION IMAGING, (FOLLOWING STRESS ECHOCARDIOGRAM, 93350); PET follow stress echo mult

G0041 00200 4 MULTIPLE STUDIES, REST OR STRESS (EXERCISE AND/OR PHARMACOLOGIC)

G0042 00100 3 PET MYOCARDIAL PERFUSION IMAGING, (FOLLOWING STRESS NUCLEAR VENTRICULOGRAM, PET follow ventriculogm sing

G0042 00200 4 78481 OR 78483); SINGLE STUDY, REST OR STRESS (EXERCISE AND/OR PHARMACOLOGIC)

G0043 00100 3 PET MYOCARDIAL PERFUSION IMAGING, (FOLLOWING STRESS NUCLEAR VENTRICULOGRAM, PET follow ventriculogm mult

G0043 00200 4 78481 OR 78483); MULTIPLE STUDIES, REST OR STRESS (EXERCISE AND/OR

G0043 00300 4 PHARMACOLOGIC)

G0044 00100 3 PET MYOCARDIAL PERFUSION IMAGING, (FOLLOWING REST ECG, 93000); SINGLE STUDY, PET following rest ECG singl

G0044 00200 4 REST OR STRESS (EXERCISE AND/OR PHARMACOLOGIC)

G0045 00100 3 PET MYOCARDIAL PERFUSION IMAGING, (FOLLOWING REST ECG, 93000); MULTIPLE PET following rest ECG mult

G0045 00200 4 STUDIES, REST OR STRESS (EXERCISE AND/OR PHARMACOLOGIC)

G0046 00100 3 PET MYOCARDIAL PERFUSION IMAGING, (FOLLOWING STRESS ECG, 93015); SINGLE STUDY, PET follow stress ECG singl

G0046 00200 4 REST OR STRESS (EXERCISE AND/OR PHARMACOLOGIC)

G0047 00100 3 PET MYOCARDIAL PERFUSION IMAGING, (FOLLOWING STRESS ECG, 93015); MULTIPLE PET follow stress ECG mult

G0047 00200 4 STUDIES, REST OR STRESS (EXERCISE AND/OR PHARMACOLOGIC)

G0101 00100 3 CERVICAL OR VAGINAL CANCER SCREENING; PELVIC AND CLINICAL BREAST EXAMINATION CA screen;pelvic/breast exam

G0102 00100 3 PROSTATE CANCER SCREENING; DIGITAL RECTAL EXAMINATION Prostate ca screening; dre

G0103 00100 3 PROSTATE CANCER SCREENING; PROSTATE SPECIFIC ANTIGEN TEST (PSA) PSA screening

G0104 00100 3 COLORECTAL CANCER SCREENING; FLEXIBLE SIGMOIDOSCOPY CA screen;flexi sigmoidscope

G0105 00100 3 COLORECTAL CANCER SCREENING; COLONOSCOPY ON INDIVIDUAL AT HIGH RISK Colorectal scrn; hi risk ind

G0106 00100 3 COLORECTAL CANCER SCREENING; ALTERNATIVE TO G0104, SCREENING SIGMOIDOSCOPY, Colon CA screen;barium enema

G0106 00200 4 BARIUM ENEMA

G0107 00100 3 COLORECTAL CANCER SCREENING; FECAL-OCCULT BLOOD TEST, 1-3 SIMULTANEOUS CA screen; fecal blood test

G0107 00200 4 DETERMINATIONS

G0108 00100 3 DIABETES OUTPATIENT SELF-MANAGEMENT TRAINING SERVICES, INDIVIDUAL, PER 30 Diab manage trn per indiv

G0108 00200 4 MINUTES

G0109 00100 3 DIABETES OUTPATIENT SELF-MANAGEMENT TRAINING SERVICES, GROUP SESSION (2 OR Diab manage trn ind/group

G0109 00200 4 MORE), PER 30 MINUTES

G0110 00100 3 NETT PULM-REHAB; EDUCATION/SKILLS TRAINING, INDIVIDUAL Nett pulm-rehab educ; ind

G0111 00100 3 NETT PULM-REHAB; EDUCATION/SKILLS TRAINING, GROUP Nett pulm-rehab educ; group

G0112 00100 3 NETT PULM-REHAB; NUTRITIONAL GUIDANCE, INITIAL Nett;nutrition guid, initial

G0113 00100 3 NETT PULM-REHAB; NUTRITIONAL GUIDANCE, SUBSEQUENT Nett;nutrition guid,subseqnt

G0114 00100 3 NETT PULM-REHAB; PSYCHOSOCIAL CONSULTATION Nett; psychosocial consult

G0115 00100 3 NETT PULM-REHAB; PSYCHOLOGICAL TESTING Nett; psychological testing

• HCPCS code

• Long & Short Description

• Pricing Indicator & Multiple Pricing Indicator

• Coverage Issues Manual & Medicare Carriers Manual

Reference

• Coverage Code

• ASC Group Payment Code and Effective Date

• MOG Payment Code, Payment Indicator, and Effective Date

HCPCS File

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• Additional information available:

– Table of Drugs

– Alphanumeric Index

HCPCS Information

• Different publishers, different contents

• Have students use a book from the same publisher

HCPCS Coding Manuals

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• A Codes - Transportation Services, Medical and Surgical Supplies, and Administrative, Miscellaneous, and Investigational

• B Codes – Enteral and Parenteral Therapy

• C Codes – Pass-Through Items

• D Codes – Dental Procedures

• E Codes – Durable Medical Equipment

• G Codes – Procedures/Professional Services

• H Codes – Alcohol and Drug Abuse Treatment Services

• J Codes – Drugs

HCPCS Format

• K Codes – DME Supplies

• L Codes – Orthotic and Prosthetic Procedures

• M Codes – Medical Services

• P Codes – Laboratory and Pathology

• Q Codes – Temporary

• R Codes – Diagnostic Radiology Services

• S Codes – Temporary National Codes

• T Codes – Medicaid State Agency Codes

• V Codes – Vision and hearing Services

• Pass-Through Items

• Hospital Outpatient Departments

• Outpatient Prospective Payment System

C - Codes

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• Durable Medical Equipment

• DMEPOS Provider

• Physician - prescription

E Codes

• Procedures/Professional Services

• Modifying definition

– Example:

• G0412 – G0415 – unilateral or bilateral

• 27215 – 27218 – unilateral only

G Codes

CPT® Coding Manual

27215

27216

27217

27218

HCPCS Coding Manual

G0412

G0413

G0414

G0415 For

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• PQRS

• Performance Measures

• G8126 – G8977

G Codes

• Drugs administered

* Watch Quantity*

J Codes

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• Temporary Codes

• Not for Medicare claims

Medicare

S Codes

• Commonly used in CPT® Coding Manual – Highlight in HCPCS

• Bracket and label like modifiers • A1 Dressing for one wound

• A2 Dressing for two wounds

• A3 Dressing for three wounds

• A4 Dressing for four wounds

• A5 Dressing for five wounds

• A6 Dressing for six wounds

• A7 Dressing for seven wounds

• A8 Dressing for eight wounds

• A9 Dressing for nine wounds

HCPCS Level II Modifiers

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• More than 275 HCPCS Level II modifiers – Remind students that CPT® modifiers can be used with HCPCS,

and HCPCS modifiers can be used with CPT

• What do HCPCS modifiers do? – Identify specific site or specific number (right thumb)

– Identify type of clinician performing service (CSW)

– Identify circumstances of DME supply (rental)

– Report statutory requirements met (ABN signed)

– Describe clinical circumstance (aphakic patient)

– Describe portion of service provided (technical component)

HCPCS Level II Modifiers