Healthcare Common Procedure Coding System (HCPCS)

Healthcare Common Procedure Coding System (HCPCS) A coding system for supplies, products, and services not included in CPT. In 1996 with the implementation of HIPAA, the use of HCPCS became mandatory. The Centers for Medicare and Medicaid Services (CMS) maintains HCPCS code sets.

Using the HCPCS manual The HCPCS manual is divided into sections: Introduction – explanation of HCPCS background, definition of HCPCS, and coding, types of HCPCS codes, modifiers, and updates. Conventions – explanation of basic steps to using the book, characters, and symbols. Code changes Deleted codes Alphabetical index – list of codes by product, supply or service name in alphabetical order. Tabular index – divided into sections by alphanumeric order of related items Appendices – Appendix A (modifiers), Appendix B (Table of drugs), Appendix C (Medicare References), Appendix D (Jurisdiction List)

Steps to choosing the proper code. Step One Consult the index – choose the main term for the product, supply, or service from the alphabetical list and select appropriate code.

Example of a code Codes are five characters long beginning with a letter and ending with four numeric digits. Example: Finger splint – Q4049

Steps to choosing the proper code. Step Two Consult the tabular list – find the code selected from the index to verify that it is the correct code. Be sure to follow any instructions directing the use of a different code, or cross-references.

Steps to choosing the proper code. Step Three Refer to the conventions – each code in the tabular have color coded letters, and symbols after it. Compare these to the conventions in the introduction for coverage, and pricing.

Steps to choosing the proper code. Step Four Add any necessary modifier – Appendix A is a full list of modifiers and their descriptions.

Example of modifiers Modifiers are two characters in length, and can be a combination of alpha and/or numeric. Examples: ET – Emergency Services NU – New equipment T1 – Left foot second digit T6 – Right foot second digit

What if I have questions on choosing a code? The process of choosing HCPCS codes is fairly simple, but if unsure, the introduction at the beginning of the book gives explanations to coding, when to use modifiers, and definitions of the symbols, and characters. It also gives the same basic steps in this power point.

References HCPCS level II: Expert 2013. (2012). Salt Lake City, UT: Contex Media Valerius, J., Bayes, N., Newby, C., & Blochowiak, A. (2014). Medical insurance: An integrated claims process approach. New York, NY: McGraw Hill.