CHAPTER 9 INTRODUCTION TO THE LEVEL II NATIONAL

HCPCS • Healthcare Common Procedure Coding System • Developed by Centers for Medicare and

Levels of Codes • Level I: CPT ___ • Level II: HCPCS, also known

Level II: _______ National Codes • Codes for wide variety of providers – Physicians

Level II: National Codes (…Cont’d) • Codes for wide variety of services – Specific

HCPCS Gains Popularity • Many payers require • Each year increased number of HCPCS

Where HCPCS Are Used • Outpatient _____ settings – Including outpatient departments in hospital

Coverage • Just because item/service has HCPCS code does NOT mean service covered –

Code Grouping • First digit is a letter • Followed by four numbers –

Temporary Codes • Certain letters (_, _, S, T) indicate G K, Q temporary

Miscellaneous Codes • Reported when no adequate Level II HCPCS code available – Serves

Updating the HCPCS Manual • Full code set update released by CMS in November

HCPCS Format Includes: • General guidelines • List of modifiers • Index • Table

HCPCS Index • Directs to specific codes • Do not code directly from index

HCPCS Index (…Cont’d) Figure 9. 4 • Alphabetical order From Buck CJ: 2017 HCPCS

Alphanumeric Listing • Further explain what is included in code • Never code from

HCPCS Modifiers Figure 9. 7 From Buck CJ: 2017 HCPCS Level II Professional Edition,

Anatomical Modifiers • F 1 Left hand, second digit • F 2 __ Left

Often Used HCPCS Modifiers • LT __ Left • RT __ Right • Example:

Ambulance Modifiers • Origin and destination used in combination: Origin – First letter: _____

Medicare Advanced Beneficiary Notice of Noncoverage (ABN) • Four ABN modifiers – GA: ABC

Medicare Advanced Beneficiary Notice of Noncoverage (ABN) (. . …Cont’d) Figure 9. 8 Centers

Table of Drugs Figure 9. 9 From Buck CJ: 2017 HCPCS Level II Professional

Routes of Administration of Drugs • J Code injections Figure 9. 10 From Buck

Durable Medical Equipment • DME • Used with chronic disabling condition • Medicare and

Home Oxygen Therapy • Medicare may also pay for oxygen with certain medical diagnoses

Conclusion CHAPTER 9 INTRODUCTION TO THE LEVEL II NATIONAL CODES (HCPCS) Copyright © 2017

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HCPCS • Healthcare Common Procedure Coding System • Developed by Centers for Medicare and CMS Medicaid Services (____) HCFA – Formerly _____ • HCPCS developed in 1983 ____ • CPT did not contain all codes necessary for Medicare services reporting Copyright © 2017 by Elsevier Inc. Slide 2

Level II: National Codes (…Cont’d) • Codes for wide variety of services – Specific drugs – ___________ Durable medical equipment (DME) – Ambulance services – Prosthetics – Orthotics – Facilities Copyright © 2017 by Elsevier Inc. Slide 5

Where HCPCS Are Used • Outpatient _____ settings – Including outpatient departments in hospital • Level I and II used to report outpatient services to certain payers Copyright © 2017 by Elsevier Inc. Slide 7

Coverage • Just because item/service has HCPCS code does NOT mean service covered – Example: – V 5130, _______ binaural hearing aid _____ – Not covered under Medicare From Cummings CW, Flint PW, Harker LA, Haughey BH, Richardson MA, Robbins KT, Schuller DE, Thomas JR, editors: Cummings Otolaryngology-Head & Neck Surgery, ed 4, Philadelphia, 2005, Mosby. Copyright © 2017 by Elsevier Inc. Slide 8

Temporary Codes • Certain letters (_, _, S, T) indicate G K, Q temporary codes – Example: K 0006 heavy duty wheelchair • Code books published every January ______ – But codes added, deleted, and revised throughout the year – Notified through carrier bulletins – Responsible to ensure most current code is assigned Copyright © 2017 by Elsevier Inc. Slide 10

Miscellaneous Codes • Reported when no adequate Level II HCPCS code available – Serves as placeholder until a more specific HCPCS code identified • Additional information required for reporting – – – Description Manufacturer name Brand/generic name, dose and NDC number (drugs) Product name and number Price • Submission of Miscellaneous Codes without this additional information results in denial Copyright © 2017 by Elsevier Inc. Slide 11

Updating the HCPCS Manual • Full code set update released by CMS in November • For use the following January • Updates provided quarterly online • Use most current HCPCS manual Copyright © 2017 by Elsevier Inc. Slide 12

HCPCS Index • Directs to specific codes • Do not code directly from index • Reference main portion text before assigning code • See Figure 9. 4 in textbook (Cont’d…) Copyright © 2017 by Elsevier Inc. Slide 14

Alphanumeric Listing • Further explain what is included in code • Never code from index Figure 9. 6 From Buck CJ: 2017 HCPCS Level II Professional Edition, St. Louis, 2017, Elsevier. Copyright © 2017 by Elsevier Inc. Slide 16

HCPCS Modifiers Figure 9. 7 From Buck CJ: 2017 HCPCS Level II Professional Edition, St. Louis, 2017, Elsevier. HCPCS modifiers used with both • CPT ___ and ______ HCPCS and CPT codes Copyright © 2017 by Elsevier Inc. Slide 17

Anatomical Modifiers • F 1 Left hand, second digit • F 2 __ Left hand, third digit • F 3 Left hand, fourth digit • F 4 Left hand, fifth digit • FA Left hand, thumb • F 5 __ Right hand, thumb • F 6 Right hand, second digit • F 7 Right hand, third digit • F 8 __ Right hand, fourth digit • F 9 Right hand, fifth digit Copyright © 2017 by Elsevier Inc. Slide 18

Ambulance Modifiers • Origin and destination used in combination: Origin – First letter: _____ Destination – Second letter: _____ – Example: -RH • R = Residence • H = Hospital • RH: origin (first letter) residence and destination (second letter) hospital Copyright © 2017 by Elsevier Inc. Slide 20

Medicare Advanced Beneficiary Notice of Noncoverage (ABN) • Four ABN modifiers – GA: ABC form signed – GX: Noncovered charges only – GY: Service/item statutorily excluded – GZ: Service/item expected to be denied • Do not report ABN modifiers together • Exception, modifier -GX with -GY (Cont’d…. . ) Copyright © 2017 by Elsevier Inc. Slide 21

Medicare Advanced Beneficiary Notice of Noncoverage (ABN) (. . …Cont’d) Figure 9. 8 Centers for Medicare and Medicaid Services Advance Beneficiary Notice (ABN) (Courtesy U. S. Department of Health and Human Services, Centers for Medicare and Medicaid Services. ) Copyright © 2017 by Elsevier Inc. Slide 22

Durable Medical Equipment • DME • Used with chronic disabling condition • Medicare and Medicaid pay for some DME items • Physician must attest to need using Certificate of Medical Necessity _________ Copyright © 2017 by Elsevier Inc. Slide 25

Home Oxygen Therapy • Medicare may also pay for oxygen with certain medical diagnoses • Physician must complete form (CMS-___) 484 attesting to medical necessity Copyright © 2017 by Elsevier Inc. Slide 26