CODING FOR THE NON-CODER HCPCS LEVEL II – HCPCS CODES SANDY SAGE R.N. This is section three of coding for the non-coder. In this section we will be reviewing and learning about level II HCPCS codes.

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 (SLIDE)

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. The purpose of the creation of HCPCS codes was to fulfill the operational needs of the Medicare reimbursement system. Use of these codes enables providers and suppliers to accurately communicate information about the supplies and services provided. Data analysis by CMS is used to establish financial controls to prevent escalation of expenses in the Medicare program.

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 HCPCS codes are an alphanumeric coding system for healthcare providers and medical suppliers to report certain drugs, medical supplies and DME. Level II codes are maintained by CMS and a HCPCS National panel that is composed of several large 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 HCPCS codes are national codes that are comprised on one letter at the beginning and then 4 numbers. Each letter designates a category. So all codes beginning with the letter A you know are medical supply codes. C codes are codes paid under OPPS> E codes are your DME codes. G and K codes are usually temporary codes that are awaiting a permanent CPT code assignment or they may only be temporarily paid by Medicare. J codes are drug codes and L codes designate orthotics and prosthetics. There are more categories and letters that can be found in your HCPCS book.

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. (SLIDE) For instance if a pacemaker procedure is charged then the pacemaker supply must be billed as well. The pacemaker itself is assigned a C code. If for some reason the insertion is charged and the pacemaker itself is not then the claim will be returned to provider for correction.

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 So we want to avoid payment denials and delays so it is important that devices are billed with the procedures that are coded. If your bills are incorrect you have to find out if you have a coding, charging or billing issue to resolve. Hopefully you have coding and billing edits in place to catch these before they are transmitted so they can be corrected on the front end. Depending on the issues you find you may have to do some process reviews at your facility.

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. (SLIDE)

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. So we discussed that C codes are device codes. They are only reported for facility technical services. That would include not only the devices but some drugs and biologicals that do not have another code assigned. As usual there are exceptions to every rule and some categories may overlap. C codes may also be eligible for OPPS pass through payment when reported.

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 Here are some examples: (SLIDE) So you can see that the MRA and the injectable drug would be exceptions to the device category. However the C codes are usually device codes.

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 E codes are only to be used by licensed DME providers for their billing. They re not brand specific just product specific like these listed.

J CODES Drugs that can not ordinarily be self administered. Chemotherapy drugs Inhalation solutions Other miscellaneous solutions J codes are drugs that can not ordinarily be self administered. That includes chemotherapy drugs, inhalation solutions and other miscellaneous drug solutions.

L CODES DME Durable Medical Equipment Orthotic and prosthetic devices Scoliosis equipment Orthopedic Shoes Prosthetic Implants (SLIDE)

Q CODES Temporary codes Cast supplies Drugs LOCM/HOCM Q9967 – LOCM 300-399 mg/ml Q codes are usually temporary codes that are awaiting CPT code assignment. They may also be cast supplies, and some drugs most commonly are the low and high osmolar contrast drugs used primarily in radiology procedures.

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