HCPCS Level II Coding Presented by Tamar Thompson, RMA, CCS-P July 14, 2004

1. HCPCS Level II CodingPresented by Tamar Thompson, RMA, CCS-PJuly 14, 2004

2. Discussion Topics What are HCPCS Codes? Nomenclature of book When to apply HCPCS Codes HCPCS vs. CPT Codes HCPCS/ICD 9 Crosswalk Modifiers Test your knowledge

3. What are HCPCS Level II Codes? HCPCS is the acronym for Healthcare Common Procedure Coding System Developed (1983) and maintained (annual updates) by CMS Codes were developed to introduce a uniformed system for providers to report procedures, services, and supplies Codes are alpha numeric: all codes begin with alpha character followed by four numeric characters Some HCPCS not reimbursable under Medicare Commercial Insurance Carriers have adopted the codes for reimbursement

4. Nomenclature Index and Organization Just as with CPT and ICD 9 codes always use the index first to locate HCPCS services or supplies before turning to the tabular Although book has designated sections for services or supplies other codes that may meet your needs are scattered throughout the book For example, V codes are designated for vision care lenses but some lens codes are listed in the S codes (S0504-S0518) section Keep this in mind when searching through the sections of the book

5. Nomenclature-A, B, and C Codes A codes - report transportation services (ambulance), med-surg supplies, administrative, and investigational services and supplies B codes - used to report supplies for enteral and parenteral therapy such as feeding tubes C codes - used to report CMS OPPS (Outpatient Prospective Payment System) under the APC C Codes are for services or supplies that CAN be billed in addition to APC for surgical services Example (C9201 Dermagraft, per 37.5 sq cm)

6. Nomenclature-D Codes D codes are used to report dental service codes The Air Force Dental Clinics do not use dental codes at this time

7. Nomenclature-E,G and H Codes E codes - used to bill or report DME (Durable Medical Equipment)- such as crutches, wheelchairs, hospital beds, etc. G codes - used to report professional healthcare procedures for which there is not a specific CPT code to identify the service� i.e., screening exams and End Stage Renal Disease related services H codes - designated for Medicaid agencies to report mental health, drug, and alcohol treatment services � these codes hold no RVU

8. Nomenclature-J Codes Used to report drugs that can not be self administered Drug table in Appendix 3 Drugs are alphabetically listed by their brand name in the drug table The table will refer to the official or generic name Not all marketed drugs are listed in J codes in these cases use unlisted code such as J3490 or J8499

9. Nomenclature-K,L, M and P Codes K codes - are temporary codes used to report DME L codes - report orthotic and prosthetic procedures and devices such as ortho-shoe, breast prosthetic, etc. M codes � other medical services i.e. cellular therapy P codes - include chemistry, screening (Pap), and blood products (actual units or pints of blood)

10. Nomenclature- Q, R, S, and T Codes Q codes - temporary codes to pay providers for supplies, services, and collections such as obtaining Pap smear Q0091 R codes - transportable x-ray S codes � temporary national codes, these codes were developed to report services and supplies for which there are no established national codes � the codes are not payable under Medicare T codes - developed for Medicaid agencies to report home health, substance abuse, and training programs such as Respite Care, Day Camp, and Hospice

11. Nomenclature- V Codes Used to report vision and hearing supplies Use these codes to report dispensing of frames and lenses for spectacles Contact lenses dispensing Hearing aids Some speech and language pathology screenings are also listed here

12. When to apply HCPCS Codes vs. CPT Codes If both a CPT and a HCPCS code exist to describe a service, use the CPT code If no CPT code exist to describe a service but a HCPCS code exist, use the HCPCS code to describe the service If no CPT or HCPCS code is listed use the appropriate unlisted CPT code to describe the service Be careful when using HCPCS codes, these codes are often times more diagnosis specific than CPT codes for example: the HCPCS code for Observation services (G0244) are SPECIFIC to facility care provided to patients with CHF, chest pain, or asthma. CPT Observation codes (9921x or 9923x) do not require specific diagnosis, the patient encounter must meet the visit criteria regardless of the diagnosis.

13. How to apply HCPCS Codes Some HCPCS Codes can stand alone others cannot For example: S0622 � Physical exam for college should be reported in addition to the appropriate E&M code and diagnosis code However, S0201 Partial hospitalization can be reported independently of a CPT code (but apply the appropriate ICD 9 code) Use HCPCS codes to report supplies needed to perform a CPT procedure For example, if an injection for Toradol is administered in the office use the CPT code 90782 to report the administration of the drug then the HCPCS J code J1885 to report the drug it self

14. HCPCS ICD 9 Crosswalk Some HCPCS codes are for diagnosis specific use These codes can only be used with a certain range of diagnosis Use this as a quality indicator for correct coding and documentation Vision codes G codes for ESRD Drug codes Ortho/Prosthetic codes Alcohol, drug abuse, and mental health codes

15. HCPCS Modifiers Listed in Appendix 1 HCPCS modifiers are alpha-alpha (-TC) or alpha numeric (-A1) characters Modifiers indicate that a service or supply has been altered from the stated description or offer additional detail needed for additional or reduced reimbursement For Example: Services submitted for billing with an �H9 (court ordered) would most likely be denied by OHI because the service was not medically necessary but rather ordered for legal purposes, OHI benefits are usually based on medical necessity HCPCS modifiers can (and should �when appropriate) be used with CPT codes For example: If CPT procedure 66984 (Extracapsular cataract removal) is performed on the right eye only then use HCPCS modifier RT to report

16. Test Your Knowledge

17. Conclusion All levels of coding can be complex, requires skill, and is very important to the facility financial planning, disease management, and reimbursement Coding can also be fun Good luck if you are sitting for the CPC on Friday Thank you!