The Complete Procedure Coding Book By Shelley C. Safian, MAOM/HSM, CCS-P, CPC-H, CHA Chapter 13 HCPCS Level II Coding Copyright © 2009 by The McGraw-Hill Companies, Inc. All rights reserved McGraw Hill/Irwin

Learning Outcomes Abstract physician’s notes to identify the need for reporting HCPCS Level II codes. Correctly use the rules and guidelines for using HCPCS Level II codes. Distinguish between CPT and HCPCS Level II codes. 13-2

Learning Outcomes Follow the directions supplied by the notations and symbols. Apply the instructions for properly coding with HCPCS Level II codes. 13-3

Introduction HCPCS Level II codes and modifiers are listed in their own book. These codes are used to report services, supplies, and health care- related equipment for patient use. 13-4

HCPCS Level II H ealthcare C ommon P rocedure C oding S ystem – Level I = CPT codes – Level II = HCPCS 13-5

HCPCS Level II Codes are 5 characters long: 1 letter followed by 4 numbers Example : C1715 Brachytherapy needle 13-6

HCPCS Level II Report the provision of: – Durable medical equipment – Pharmaceuticals administered by a health care professional – Medical supplies provided for the patient’s own use – Dental services – Transportation services – Vision and hearing services – Orthotic and prosthetic procedures 13-7

HCPCS Level II Medicare and Medicaid approved Some private third-party payers accept HCPCS Level II codes - you must ask! 13-8

HCPCS Level II Alphabetic index lists codes by: Brand name of drug Generic name of drug Medical supply item Orthotic Prosthetic Service Surgical supply 13-9

HCPCS Level II Alphanumeric listing shows codes by: Alphabetic order by first letter of code. Numeric order of the numbers that follow

HCPCS Level II Section D All of these codes are maintained by the American Dental Association. They are also published in their own book, Current Dental Terminology (CDT) for use in dental practices

HCPCS Level II Use a HCPCS II code when: A regular CPT code is not appropriate, AND A HCPCS II code is appropriate

HCPCS Level II Symbols A large bullet indicates a new code.  A black triangle indicates a revised code.  An open circle indicates a reinstated code

HCPCS Level II Symbols  An open circle with a line indicates covered under the Skilled Nursing Facility prospective payment system.  A check mark inside a little box indicates that the code description includes a specific amount or quantity

HCPCS Level II Notations This notation directs you to include at least one other code when reporting this code. Example : Always report concurrent to the implant procedure

HCPCS Level II Notations This notation cross- references this code with another that may be similar in description. Example : See also code A

HCPCS Level II Notations Clarification of coverage notations direct you to sue, or not use, a code Example : Dressings applied by a physician are included as part of the professional service

HCPCS Level II Notations Similar to an add-on notation in CPT, this directs the coder to include another code when reporting this code. Example : Report in addition to code D

HCPCS Level II Notations Most often seen below a deleted code description, this notation directs you to another similar code that is still active. Example : See code Z

HCPCS Level II Notations This notation directs the coder to another, possibly more specific code. Example : See code(s):

HCPCS Level II Notations This directs the coder to first search for a better code before choosing this code. Example : Determine if an alternative HCPCS Level II or a CPT code better describes… 13-21

HCPCS Level II Notations This notation provides alternate terms and/or names included in the scope of this code description. Example : Use this code for… 13-22

HCPCS Level II Notations This notation suggests that supplemental documentation be included with the use of this claim. Example : Pertinent documentation to evaluate medical appropriateness should be… 13-23

HCPCS Level II Notations This notation identifies restrictions on using this particular code. Example : Do not use this code to report the first stage of root canal therapy

HCPCS Level II Notations These notations provide additional information about Medicare coverage on the federal level. Example : Medicare covers… 13-25

HCPCS Level II Notations This notation warns that the code should be used very carefully, with great assurance that it is the most specific. Example : Code with caution: 13-26

HCPCS Level II Appendixes Appendix 1: Table of Drugs Appendix 2: Modifiers Appendix 3: Abbreviations and Acronyms Appendix 4: PUB100 References Appendix 5: New, Changed, Deleted, and Reinstated HCPCS Codes Appendix 6: Place of Service and Type of Service Codes 13-27

Chapter Summary HCPCS Level II codes may be applicable to services and procedures provided in many types of health care facilities