When it comes to medical coding, you are often presented with various code sets that contain similar codes. It becomes difficult, therefore, to determine which code set or code to use in a particular situation. More so in the case of coding within HCPCS and CPT, where it poses challenges to seasoned and inexperienced coders alike.
HCPCS is short for Healthcare Common Procedure Coding Systems. Normally when medical billers and coders are talking about HCPCS codes, they are referring to HCPCS Level II codes. HCPCS codes make up the national procedure code set that is used by medical equipment suppliers, healthcare providers, and practitioners alike to file medical claims for medical supplies, devices, medication, and transportation services, among others.
HCPCS Level II code set is the most dynamic among other medical code sets. For one, the codes are updated frequently throughout the year by the CMS, based on feedback from the parties involved in the medical claim process. The recurring revisions are one of the many reasons why you need a reputable medical billing company like UControl Billing to boost your productivity and improve your reporting accuracy.
Developed by the Centers for Medicare and Medicaid for the purpose of accurately reporting and documenting medical services and procedures, HCPCS was optional till 1996. In that year, the Health Information Portability and Accountability Act (HIPAA) was passed by the government which made it mandatory for medical procedures and billing.
HCPCS Levels of codes
The HCPCS codes list if used by coders to denote medical services to Medicaid, Medicare, and many other third-party payers. The code set is divided into three levels, which are:
Level I: These are mainly AMA’s CPT codes and are numeric, representing medical procedures and services.
Level II: The level II codes list consist of alphanumeric codes and includes only non-physician products, supplies, and procedures that are excluded from CPT.
Level III: Also called HCPCS local codes, this code set is developed by Medicare and Medicaid contractors and private insurers to be used in specific scenarios and jurisdictions. Therefore, they are not nationally recognized.
Level II HCPCS Codes
Normally when medical billers and coders are talking about HCPCS codes, they are referring to HCPCS Level II codes. Level II codes are developed to denote non-physician services which include wheelchairs, ambulance rides, medical equipment, and those medical procedures that do not fit in the Level I code set.
Where CPT codes describe the medical procedure that took place, it lacks the information about the medical equipment that was used in the procedure. HCPCS codes are then used to represent all those medical equipment and products that were used.
Level II codes are, like Level I, five characters long, but Level II codes are alphanumeric, with a letter occupying the first character of the code. These codes, like those in ICD and CPT, are grouped together by the services they describe and are in numeric order.
Divisions within HCPCS
The following sections can be found in the HCPCS manual:
A Codes – transportation, medical and surgical supplies, miscellaneous and experimental
B codes – enteral and parenteral therapy
C codes – temporary hospital OPPS
E codes – durable medical equipment
G codes – temporary procedures and professional services
H codes – behavioral health/substance abuse services
J codes – drugs administered other than oral method, chemotherapy drugs
K codes – temporary codes for durable medical equipment regional carriers
L codes – orthotic/prosthetic procedures
M codes – other medical services
P codes – pathology and laboratory
Q codes – temporary codes (limited use and guidelines specific)
R codes – diagnostic radiology services
S codes – temporary national codes (non-Medicare) codes
T codes – temporary state Medicaid agency codes
V codes – vision/hearing services
Coding with HCPCS
To start with, the HCPCS manual has an index and a comprehensive table of drugs that should be used by coders when coding regarding the delivery of medication or drugs. Coding for medication is one of the most essential parts of the HCPCS code set, and the drug table will always come in use when finding the correct code.
Coding with HCPCS is similar to CPT or ICD codes. When you receive a medical report to be claimed, you as a code will identify the procedures that were performed, the prescribed products, and any other service is given. Finally, you will refer to your HCPCS code set to look up the appropriate codes to go against the services incurred.
As compared to coding with CPT, HCPCS coding requires an even higher level of accuracy in specificity. That is because the code set has codes for the numerous equipment and medicine, plus for the different variations which can become lengthy at times. In this case, you need to stay as close to the medical report as possible to ensure that you are coding the right procedure with the correct codes.
HCPCS vs. CPT
CPT code set is developed and maintained by the American Medical Association and describes surgical, diagnostic, and medical services accurately. CPT or Current Procedural Terminology acts as a uniform communication among healthcare providers, patients, coders, payers about medical services and procedures.
The HCPCS codes, on the other hand, are based on the CPT codes and describe those items and services that were used in the delivery of healthcare. HCPCS coding is necessary when Medicaid, Medicare, and other health insurance programs are involved.
When it comes to public knowledge, CPT codes are not particularly private. But the AMA has sole copyright over the codes and charges a license fee to those who want to compare the PT codes to the Relative Value Unit. For HCPCS codes, the practices are public records and can be accessed freely by those who use Medicare, Medicaid, or any other private insurer to ensure that practices are being followed accurately. Though the use of codes was voluntary at its inception, beginning in 1996 the Health Insurance Portability and Accountability Act made it mandatory for this information to be easily accessible by physicians, technicians, and patients alike.
HCPCS Level II is a standardized coding system that is used to identify supplies, products, and services that are not in the CPT codes. Since Medicare, Medicaid, and other insurers cover numerous services and supplies that are not identified by the CPT code set, that is where the level II HCPCS codes are used when submitting claims.
The HCPCS code set gets updated constantly, and like the CPT codes, HCPCS alerts you about all new codes as well as the ones which have been revised. HCPCS features a number of strikethrough codes, and these let you know that a code that used to be listed there has been deleted and moved elsewhere.