Procedural Coding: Introduction to HCPCS Chapter 6

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Procedural Coding: Introduction to HCPCS Chapter 6 © 2010 The McGraw-Hill Companies, Inc. All rights reserved.

Learning Outcomes After studying this chapter, you should be able to: 6.1 Discuss the purpose of the HCPCS code set. 6.2 Explain how to locate the periodic updates to HCPCS codes. 6.3 Describe the structure and content of the index, the Table of Drugs, and the main text in HCPCS. Chapter 6

Learning Outcomes (Continued) 6.4 Describe the purpose and correct use of HCPCS modifiers. 6.5 List the steps for assigning correct HCPCS codes and modifiers. 6.6 Discuss the tools used to verify billing rules for specific HCPCS codes. Chapter 6

Key Terms CMS HCPCS Workgroup Coverage Issues Manual (CIM) Durable medical equipment (DME) Durable medical equipment, prosthetics, orthotics, and supplies (DMEPOS) Durable Medical Equipment Regional Carrier (DMERC) Healthcare Common Procedure Coding System (HCPCS) Level II Level II modifiers Chapter 6

Key Terms (Continued) Medicare Carriers Manual (MCM) Permanent national codes Statistical analysis durable medical equipment carrier (SADMERC) Temporary national codes Chapter 6

Overview of HCPCS H Healthcare C Common P Procedure C Coding S System Medical procedures, products, services not in CPT Mandated HIPAA code set Maintained by CMS Chapter 6

Level II Codes Five characters: Letter and four numbers Tabular list contains sections for each type of service Often code durable medical equipment (DME), supplies, drugs, and services/procedures not in CPT level I such as transportation, orthotics/prosthetics, and vision/hearing services, as well as a large section of temporary codes New services are assigned temporary CMS or national codes released quarterly Permanent codes updated annually Chapter 6

HCPCS Coding Procedures Coding Steps: Look up item in the index Verify code selection using the Tabular List Report quantities carefully—the code must match the route and the dose Assign Level II modifiers as appropriate Chapter 6

HCPCS Billing Procedures Billing Medicare Review symbols for: Not covered by or valid for Medicare Special coverage instructions apply Carrier discretion And then review Medicare rules: Medicare Carriers Manual (MCM) Coverage Issues Manual (CIM) Chapter 6

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