Transcript Document

HS 225 Unit 5 Presentation
Chapter 23: HCPCS Codes
1
Overview
 Healthcare Common Procedure Coding System is
referred to using the acronym HCPCS,
 Two levels
 HCPCS level I
 HCPCS level II
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HCPCS Level I
 Five-digit CPT codes and two-digit
modifiers
 Developed by American Medical
Association (AMA)
 Updated annually-Jan. 1
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HCPCS Level II
 HCPCS national codes and twocharacter modifiers
 Describe common medical services
and supplies not classified in CPT
 Five characters in length
 Begin with letters A–V, followed by four
numbers
 For example, abdominal aneurysm wrap
(M0301)
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Durable Medical Equipment (DME)
 Can withstand repeated use
 Primarily used to serve a medical
purpose
 Used in patient’s home
 Would not be used in the absence of
illness or injury
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HCPCS Level II National Codes
 Classify similar medical products and
services for claims processing
 Each code contains a description:
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

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DME
Medications
Provider services
Temporary Medicare codes (e.g., Q codes)
Other items and services (e.g., ambulance)
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HCPCS Level II National Codes
 HCPCS National Panel responsible
 Panel consists of:
 Blue Cross/Blue Shield Association
 Health Insurance Association of America
 CMS
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Certificate of Medical Necessity for
DME
 A Certificate of Medical Necessity
clearly explains why a physician feels
a patient needs the DME item or
service.
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Advance Beneficiary Notice
 Waiver signed by patient
 Acknowledges that, since medical
necessity for a procedure, service, or
supply cannot be established, patient
accepts responsibility for reimbursing
provider or durable medical equipment,
prosthetic, and orthotic supplies
(DMEPOS) dealer for costs associated
with procedure, service, or supply.
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HCPCS Level II Coding Tips
 The coder should be sure that a
HCPCS Level I code is not available
before assigning a HCPCS Level II
code.
 The coder needs to read the selected
code carefully because some codes
indicate “each” or “per,” so the
quantity reported may need to be
more than one (1)
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HCPCS Level II
 Organized by type
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Permanent national codes
Miscellaneous codes
Temporary codes
Modifiers
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HCPCS Level II
 Medical and Surgical Supplies
(A4000-A8999)
 Administrative, Miscellaneous and
Investigational (A9000-A999)
 Enteral and Parenteral Therapy
(B4000-B9999)
 Dental procedures (D0000-D9999)
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HCPCS Level II
 DME (E0100-E999)
 Procedures/Professional Services
(Temporary) (G0000–G9999)
 Alcohol and/or Drug Abuse Treatment
Services (H0001–H2037)
 Drugs Administered other than Oral
Method (J0000–J9999)
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(continued)
HCPCS Level II

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
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Temporary codes (K0000-K9999)
Orthotic Procedures (L0000–L4999)
Prosthetic Procedures (L5000–L9999)
Medical Services (M0000–M0301)
Pathology and Laboratory Services
(P0000–P9999)
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HCPCS Level II J Codes
Permission to
reuse in
accordance with
http://www.cms.hhs.
gov Web site
Content Reuse
Policy.
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HCPCS Level II
 Q codes (temporary) (Q0000–Q9999)
 Diagnostic radiology services (R0000–
R5999)
 Temporary national codes (nonMedicare)(S0000-S9999)
 National T codes established for state
Medicaid agencies (T1000–T9999)
 Vision services (V0000-V2999)
 Hearing services (V5000-V5999)
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CPT Symbols
 Bullet located to the left of code
identifies new procedures and
services (●)
 Triangle located to the left of code
identifies revision of code description
(▲)
 Horizontal triangles surround revised
guidelines and notes (►◄)
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Level I & II Modifiers
 Clarify services and procedures
performed by providers
 Reported as two-digit numeric codes
added to five-digit CPT code
 HCPCS level II national two-digit
alpha-numeric modifiers also are
added to five-digit CPT code
 Not all codes require modifiers
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(continued)
Special E/M Cases
 -21 Prolonged E/M services
 -24 Unrelated E/M service by same
physician during postoperative period
 -25 Significant, separately identifiable
E/M service by same physician on
same day of procedure or other
service
 -57 Decision for surgery
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Greater, Reduced, or Discontinued
Services
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-22 Increased procedural services
-52 Reduced services
-53 Discontinued procedure
-73 Discontinued outpatient
hospital/
ambulatory surgery center
procedure prior to anesthesia
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(continued)
Greater, Reduced, or Discontinued
Services
 -74 Discontinued outpatient
hospital/
ambulatory surgery center
procedure after anesthesia
administration
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Global Surgery
 -54 Surgical care only
 -55 Postoperative management only
 -56 Preoperative management only
22
Special Surgical and Procedural
Events
 -58 Staged or related procedure or
service by same physician
 -59 Distinct procedural service
 -63 Procedure performed on infants
less than 4 kilograms (kg)
23
(continued)
Special Surgical and Procedural
Events
 -78 Return to operating room for
related procedure during
postoperative period
 -79 Unrelated procedure or service
by same physician during
postoperative period
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Bilateral and Multiple Procedures
 -50 Bilateral procedure
 -27 Multiple outpatient hospital E/M
encounters on same date
 -51 Multiple procedures
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Repeat Services
 -76 Repeat procedure by same
physician
 -77 Repeat procedure by another
physician
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Multiple Surgeons
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-62 Two surgeons
-66 Surgical team
-80 Assistant surgeon
-81 Minimum assistant surgeon
-82 Assistant surgeon (when qualified
resident not available)
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Professional and Technical
Components
 -26 Professional
Component
 -TC Technical
Component
(found in HCPCS
level II manual)
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Mandated Services
 -32 Mandated
services
 -23 Unusual
anesthesia
 -47 Anesthesia by
surgeon
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Laboratory Services
 -90 Reference
(outside)
laboratory
 -91 Repeat clinical
diagnostic
laboratory test
 -92 Alternative
laboratory platform
testing
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Multiple Modifiers
 -99 Multiple
modifiers
 Used to alert third
party payer that
there are more
than four modifiers
on the CPT
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Questions
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