Live or Die by the Guidelines: HCPCS Level II

Transcription

1 Live or Die by the Guidelines: HCPCS Level II AMA Disclaimer Common Procedural Terminology (CPT ) codes, descriptions, and material only are Copyright 2013 American Medical Association (AMA). All Rights Reserved. No fee schedules, basic units, relative values, or related listings are included in CPT. The AMA assumes no liability for the data contained herein. Applicable FARS/DFARS restrictions apply to government use. CPT is a registered trademark of the American Medical Association. 1

2 Goals Be alert to confusion over term HCPCS Understand the variety of goods and services that can be reported with HCPCS Level II codes Review concepts on when HCPCS Level II codes are appropriate See importance of teaching HCPCS to your students HCPCS Healthcare Common Procedural Coding System This designation comes from CMS, and encompasses: HCPCS Level I, national CPT codes HCPCS Level II, supplemental codes for supplies and procedures HCPCS Level III, defunct local coding system 2

3 HCPCS Level II Before pursuing a HCPCS Level II code, ask, Is this a routine supply? Routine supply is not reported Nonroutine supply is reported Also ask, Is the place of service appropriate for HCPCS Level II code reporting? HCPCS Level II HCPCS Level II created by CMS But that doesn t mean all codes are covered Some are never covered, by statutory law Some coverage is determined locally 3

4 HCPCS Level II Alpha-numeric Report supplies as well as, services not included in CPT New HCPCS codes are evaluated in public hearings held in Baltimore Updated continually, although most updates are implemented January 1 Permanent codes HCPCS Level II Report supplies or services that would never be issued a CPT code Temporary codes Meet, within a short time, the need for a national code May be retained over time May be replaced by a CPT code 4

5 HCPCS Level II Temporary codes C codes for HOPPS G codes for procedures not in CPT (for example, PQRI codes) K codes for temporary DME Q codes for drugs and biologicals that haven t been assigned permanent codes S codes for private sectors reporting requirements T codes for Medicaid agencies HCPCS Level II Information Medicare Coding HCPCS Release & Code Sets 5

6 HCPC Seq Num RIC Long Description Short Description G ADMINISTRATION OF INFLUENZA VIRUS VACCINE Admin influenza virus vac G ADMINISTRATION OF PNEUMOCOCCAL VACCINE Admin pneumococcal vaccine G ADMINISTRATION OF HEPATITIS B VACCINE Admin hepatitis b vaccine G SEMEN ANALYSIS; PRESENCE AND/OR MOTILITY OF SPERM EXCLUDING HUHNER Semen analysis G PET MYOCARDIAL PERFUSION IMAGING, (FOLLOWING PREVIOUS PET, G0030-G0047); SINGLE PET imaging prev PET single G STUDY, REST OR STRESS (EXERCISE AND/OR PHARMACOLOGIC) G PET MYOCARDIAL PERFUSION IMAGING, (FOLLOWING PREVIOUS PET, G0030-G0047); PET imaging prev PET multple G MULTIPLE STUDIES, REST OR STRESS (EXERCISE AND/OR PHARMACOLOGIC) G PET MYOCARDIAL PERFUSION IMAGING, (FOLLOWING REST SPECT, 78464); SINGLE STUDY, PET follow SPECT singl G REST OR STRESS (EXERCISE AND/OR PHARMACOLOGIC) G PET MYOCARDIAL PERFUSION IMAGING, (FOLLOWING REST SPECT, 78464); MULTIPLE PET follow SPECT mult G STUDIES, REST OR STRESS (EXERCISE AND/OR PHARMACOLOGIC) G PET MYOCARDIAL PERFUSION IMAGING, (FOLLOWING STRESS SPECT, 78465); SINGLE PET follow SPECT singl G STUDY, REST OR STRESS (EXERCISE AND/OR PHARMACOLOGIC) G PET MYOCARDIAL PERFUSION IMAGING, (FOLLOWING STRESS SPECT, 78465); MULTIPLE PET follow SPECT mult G STUDIES, REST OR STRESS (EXERCISE AND/OR PHARMACOLOGIC) G PET MYOCARDIAL PERFUSION IMAGING, (FOLLOWING CORONARY ANGIOGRAPHY, PET follow cornry angio sing G ); SINGLE STUDY, REST OR STRESS (EXERCISE AND/OR PHARMACOLOGIC) G PET MYOCARDIAL PERFUSION IMAGING, (FOLLOWING CORONARY ANGIOGRAPHY, PET follow cornry angio mult G ); MULTIPLE STUDIES, REST OR STRESS (EXERCISE AND/OR PHARMACOLOGIC) G PET MYOCARDIAL PERFUSION IMAGING, (FOLLOWING STRESS PLANAR MYOCARDIAL PET follow myocard perf sing G PERFUSION, 78460); SINGLE STUDY, REST OR STRESS (EXERCISE AND/OR PHARMACOLOGIC) G PET MYOCARDIAL PERFUSION IMAGING, (FOLLOWING STRESS PLANAR MYOCARDIAL PET follow myocard perf mult G PERFUSION, 78460); MULTIPLE STUDIES, REST OR STRESS (EXERCISE AND/OR G PHARMACOLOGIC) G PET MYOCARDIAL PERFUSION IMAGING, (FOLLOWING STRESS ECHOCARDIOGRAM, 93350); PET follow stress echo singl G SINGLE STUDY, REST OR STRESS (EXERCISE AND/OR PHARMACOLOGIC) G PET MYOCARDIAL PERFUSION IMAGING, (FOLLOWING STRESS ECHOCARDIOGRAM, 93350); PET follow stress echo mult G MULTIPLE STUDIES, REST OR STRESS (EXERCISE AND/OR PHARMACOLOGIC) G PET MYOCARDIAL PERFUSION IMAGING, (FOLLOWING STRESS NUCLEAR VENTRICULOGRAM, PET follow ventriculogm sing G OR 78483); SINGLE STUDY, REST OR STRESS (EXERCISE AND/OR PHARMACOLOGIC) G PET MYOCARDIAL PERFUSION IMAGING, (FOLLOWING STRESS NUCLEAR VENTRICULOGRAM, PET follow ventriculogm mult G OR 78483); MULTIPLE STUDIES, REST OR STRESS (EXERCISE AND/OR G PHARMACOLOGIC) G PET MYOCARDIAL PERFUSION IMAGING, (FOLLOWING REST ECG, 93000); SINGLE STUDY, PET following rest ECG singl G REST OR STRESS (EXERCISE AND/OR PHARMACOLOGIC) G PET MYOCARDIAL PERFUSION IMAGING, (FOLLOWING REST ECG, 93000); MULTIPLE PET following rest ECG mult G STUDIES, REST OR STRESS (EXERCISE AND/OR PHARMACOLOGIC) G PET MYOCARDIAL PERFUSION IMAGING, (FOLLOWING STRESS ECG, 93015); SINGLE STUDY, PET follow stress ECG singl G REST OR STRESS (EXERCISE AND/OR PHARMACOLOGIC) G PET MYOCARDIAL PERFUSION IMAGING, (FOLLOWING STRESS ECG, 93015); MULTIPLE PET follow stress ECG mult G STUDIES, REST OR STRESS (EXERCISE AND/OR PHARMACOLOGIC) G CERVICAL OR VAGINAL CANCER SCREENING; PELVIC AND CLINICAL BREAST EXAMINATION CA screen;pelvic/breast exam G PROSTATE CANCER SCREENING; DIGITAL RECTAL EXAMINATION Prostate ca screening; dre G PROSTATE CANCER SCREENING; PROSTATE SPECIFIC ANTIGEN TEST (PSA) PSA screening G COLORECTAL CANCER SCREENING; FLEXIBLE SIGMOIDOSCOPY CA screen;flexi sigmoidscope G COLORECTAL CANCER SCREENING; COLONOSCOPY ON INDIVIDUAL AT HIGH RISK Colorectal scrn; hi risk ind G COLORECTAL CANCER SCREENING; ALTERNATIVE TO G0104, SCREENING SIGMOIDOSCOPY, Colon CA screen;barium enema G BARIUM ENEMA G COLORECTAL CANCER SCREENING; FECAL-OCCULT BLOOD TEST, 1-3 SIMULTANEOUS CA screen; fecal blood test G DETERMINATIONS G DIABETES OUTPATIENT SELF-MANAGEMENT TRAINING SERVICES, INDIVIDUAL, PER 30 Diab manage trn per indiv G MINUTES G DIABETES OUTPATIENT SELF-MANAGEMENT TRAINING SERVICES, GROUP SESSION (2 OR Diab manage trn ind/group G MORE), PER 30 MINUTES G NETT PULM-REHAB; EDUCATION/SKILLS TRAINING, INDIVIDUAL Nett pulm-rehab educ; ind G NETT PULM-REHAB; EDUCATION/SKILLS TRAINING, GROUP Nett pulm-rehab educ; group G NETT PULM-REHAB; NUTRITIONAL GUIDANCE, INITIAL Nett;nutrition guid, initial G NETT PULM-REHAB; NUTRITIONAL GUIDANCE, SUBSEQUENT Nett;nutrition guid,subseqnt G NETT PULM-REHAB; PSYCHOSOCIAL CONSULTATION Nett; psychosocial consult G NETT PULM-REHAB; PSYCHOLOGICAL TESTING Nett; psychological testing HCPCS code Long & Short Description Pricing Indicator & Multiple Pricing Indicator Coverage Issues Manual & Medicare Carriers Manual Reference Coverage Code HCPCS File ASC Group Payment Code and Effective Date MOG Payment Code, Payment Indicator, and Effective Date 6

7 HCPCS Information Additional information available: Table of Drugs Alphanumeric Index HCPCS Coding Manuals Different publishers, different contents Have students use a book from the same publisher 7

8 HCPCS Format A Codes - Transportation Services, Medical and Surgical Supplies, and Administrative, Miscellaneous, and Investigational B Codes Enteral and Parenteral Therapy C Codes Pass-Through Items D Codes Dental Procedures E Codes Durable Medical Equipment G Codes Procedures/Professional Services H Codes Alcohol and Drug Abuse Treatment Services J Codes Drugs K Codes DME Supplies L Codes Orthotic and Prosthetic Procedures M Codes Medical Services P Codes Laboratory and Pathology Q Codes Temporary R Codes Diagnostic Radiology Services S Codes Temporary National Codes T Codes Medicaid State Agency Codes V Codes Vision and hearing Services C - Codes Pass-Through Items Hospital Outpatient Departments Outpatient Prospective Payment System 8

9 For Medicare, see G0412-G0415 See also, E Codes Durable Medical Equipment DMEPOS Provider Physician - prescription Procedures/Professional Services Modifying definition G Codes Example: G0412 G0415 unilateral or bilateral unilateral only CPT Coding Manual HCPCS Coding Manual G0412 G0413 G0414 G0415 9

10 G Codes PQRS Performance Measures G8126 G8977 Drugs administered J Codes * Watch Quantity* 10

11 Dressings S Codes Temporary Codes Not for Medicare claims Medicare Commonly used in CPT Coding Manual Highlight in HCPCS Bracket and label like modifiers A1 A2 A3 A4 A5 A6 A7 A8 A9 HCPCS Level II Modifiers Dressing for one wound Dressing for two wounds Dressing for three wounds Dressing for four wounds Dressing for five wounds Dressing for six wounds Dressing for seven wounds Dressing for eight wounds Dressing for nine wounds 11

12 HCPCS Level II Modifiers More than 275 HCPCS Level II modifiers Remind students that CPT modifiers can be used with HCPCS, and HCPCS modifiers can be used with CPT What do HCPCS modifiers do? Identify specific site or specific number (right thumb) Identify type of clinician performing service (CSW) Identify circumstances of DME supply (rental) Report statutory requirements met (ABN signed) Describe clinical circumstance (aphakic patient) Describe portion of service provided (technical component) 12