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Live or Die by the Guidelines:
HCPCS Level II
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.
AMA Disclaimer
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• 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
Goals
• 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
HCPCS
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• 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
HCPCS – Level II
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• Alpha-numeric
• Report supplies as well as, services not included in CPT®
• New HCPCS codes are evaluated in public hearings held in Baltimore
– http://www.cms.gov/MedHCPCSGenInfo/08_HCPCSPublicMeetings.asp
• Updated continually, although most updates are implemented January 1
HCPCS – Level II
• Permanent codes
– 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
HCPCS – Level II
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• 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
http://www.cms.gov/HCPCSReleaseCodeSets/ANHCPCS/list.asp
• www.cms.gov
• Medicare
• Coding
• HCPCS Release & Code Sets
HCPCS Level II Information
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HCPC Seq Num RIC Long Description Short Description
G0008 00100 3 ADMINISTRATION OF INFLUENZA VIRUS VACCINE Admin influenza virus vac
G0009 00100 3 ADMINISTRATION OF PNEUMOCOCCAL VACCINE Admin pneumococcal vaccine
G0010 00100 3 ADMINISTRATION OF HEPATITIS B VACCINE Admin hepatitis b vaccine
G0027 00100 3 SEMEN ANALYSIS; PRESENCE AND/OR MOTILITY OF SPERM EXCLUDING HUHNER Semen analysis
G0030 00100 3 PET MYOCARDIAL PERFUSION IMAGING, (FOLLOWING PREVIOUS PET, G0030-G0047); SINGLE PET imaging prev PET single
G0030 00200 4 STUDY, REST OR STRESS (EXERCISE AND/OR PHARMACOLOGIC)
G0031 00100 3 PET MYOCARDIAL PERFUSION IMAGING, (FOLLOWING PREVIOUS PET, G0030-G0047); PET imaging prev PET multple
G0031 00200 4 MULTIPLE STUDIES, REST OR STRESS (EXERCISE AND/OR PHARMACOLOGIC)
G0032 00100 3 PET MYOCARDIAL PERFUSION IMAGING, (FOLLOWING REST SPECT, 78464); SINGLE STUDY, PET follow SPECT 78464 singl
G0032 00200 4 REST OR STRESS (EXERCISE AND/OR PHARMACOLOGIC)
G0033 00100 3 PET MYOCARDIAL PERFUSION IMAGING, (FOLLOWING REST SPECT, 78464); MULTIPLE PET follow SPECT 78464 mult
G0033 00200 4 STUDIES, REST OR STRESS (EXERCISE AND/OR PHARMACOLOGIC)
G0034 00100 3 PET MYOCARDIAL PERFUSION IMAGING, (FOLLOWING STRESS SPECT, 78465); SINGLE PET follow SPECT 76865 singl
G0034 00200 4 STUDY, REST OR STRESS (EXERCISE AND/OR PHARMACOLOGIC)
G0035 00100 3 PET MYOCARDIAL PERFUSION IMAGING, (FOLLOWING STRESS SPECT, 78465); MULTIPLE PET follow SPECT 78465 mult
G0035 00200 4 STUDIES, REST OR STRESS (EXERCISE AND/OR PHARMACOLOGIC)
G0036 00100 3 PET MYOCARDIAL PERFUSION IMAGING, (FOLLOWING CORONARY ANGIOGRAPHY, PET follow cornry angio sing
G0036 00200 4 93510-93529); SINGLE STUDY, REST OR STRESS (EXERCISE AND/OR PHARMACOLOGIC)
G0037 00100 3 PET MYOCARDIAL PERFUSION IMAGING, (FOLLOWING CORONARY ANGIOGRAPHY, PET follow cornry angio mult
G0037 00200 4 93510-93529); MULTIPLE STUDIES, REST OR STRESS (EXERCISE AND/OR PHARMACOLOGIC)
G0038 00100 3 PET MYOCARDIAL PERFUSION IMAGING, (FOLLOWING STRESS PLANAR MYOCARDIAL PET follow myocard perf sing
G0038 00200 4 PERFUSION, 78460); SINGLE STUDY, REST OR STRESS (EXERCISE AND/OR PHARMACOLOGIC)
G0039 00100 3 PET MYOCARDIAL PERFUSION IMAGING, (FOLLOWING STRESS PLANAR MYOCARDIAL PET follow myocard perf mult
G0039 00200 4 PERFUSION, 78460); MULTIPLE STUDIES, REST OR STRESS (EXERCISE AND/OR
G0039 00300 4 PHARMACOLOGIC)
G0040 00100 3 PET MYOCARDIAL PERFUSION IMAGING, (FOLLOWING STRESS ECHOCARDIOGRAM, 93350); PET follow stress echo singl
G0040 00200 4 SINGLE STUDY, REST OR STRESS (EXERCISE AND/OR PHARMACOLOGIC)
G0041 00100 3 PET MYOCARDIAL PERFUSION IMAGING, (FOLLOWING STRESS ECHOCARDIOGRAM, 93350); PET follow stress echo mult
G0041 00200 4 MULTIPLE STUDIES, REST OR STRESS (EXERCISE AND/OR PHARMACOLOGIC)
G0042 00100 3 PET MYOCARDIAL PERFUSION IMAGING, (FOLLOWING STRESS NUCLEAR VENTRICULOGRAM, PET follow ventriculogm sing
G0042 00200 4 78481 OR 78483); SINGLE STUDY, REST OR STRESS (EXERCISE AND/OR PHARMACOLOGIC)
G0043 00100 3 PET MYOCARDIAL PERFUSION IMAGING, (FOLLOWING STRESS NUCLEAR VENTRICULOGRAM, PET follow ventriculogm mult
G0043 00200 4 78481 OR 78483); MULTIPLE STUDIES, REST OR STRESS (EXERCISE AND/OR
G0043 00300 4 PHARMACOLOGIC)
G0044 00100 3 PET MYOCARDIAL PERFUSION IMAGING, (FOLLOWING REST ECG, 93000); SINGLE STUDY, PET following rest ECG singl
G0044 00200 4 REST OR STRESS (EXERCISE AND/OR PHARMACOLOGIC)
G0045 00100 3 PET MYOCARDIAL PERFUSION IMAGING, (FOLLOWING REST ECG, 93000); MULTIPLE PET following rest ECG mult
G0045 00200 4 STUDIES, REST OR STRESS (EXERCISE AND/OR PHARMACOLOGIC)
G0046 00100 3 PET MYOCARDIAL PERFUSION IMAGING, (FOLLOWING STRESS ECG, 93015); SINGLE STUDY, PET follow stress ECG singl
G0046 00200 4 REST OR STRESS (EXERCISE AND/OR PHARMACOLOGIC)
G0047 00100 3 PET MYOCARDIAL PERFUSION IMAGING, (FOLLOWING STRESS ECG, 93015); MULTIPLE PET follow stress ECG mult
G0047 00200 4 STUDIES, REST OR STRESS (EXERCISE AND/OR PHARMACOLOGIC)
G0101 00100 3 CERVICAL OR VAGINAL CANCER SCREENING; PELVIC AND CLINICAL BREAST EXAMINATION CA screen;pelvic/breast exam
G0102 00100 3 PROSTATE CANCER SCREENING; DIGITAL RECTAL EXAMINATION Prostate ca screening; dre
G0103 00100 3 PROSTATE CANCER SCREENING; PROSTATE SPECIFIC ANTIGEN TEST (PSA) PSA screening
G0104 00100 3 COLORECTAL CANCER SCREENING; FLEXIBLE SIGMOIDOSCOPY CA screen;flexi sigmoidscope
G0105 00100 3 COLORECTAL CANCER SCREENING; COLONOSCOPY ON INDIVIDUAL AT HIGH RISK Colorectal scrn; hi risk ind
G0106 00100 3 COLORECTAL CANCER SCREENING; ALTERNATIVE TO G0104, SCREENING SIGMOIDOSCOPY, Colon CA screen;barium enema
G0106 00200 4 BARIUM ENEMA
G0107 00100 3 COLORECTAL CANCER SCREENING; FECAL-OCCULT BLOOD TEST, 1-3 SIMULTANEOUS CA screen; fecal blood test
G0107 00200 4 DETERMINATIONS
G0108 00100 3 DIABETES OUTPATIENT SELF-MANAGEMENT TRAINING SERVICES, INDIVIDUAL, PER 30 Diab manage trn per indiv
G0108 00200 4 MINUTES
G0109 00100 3 DIABETES OUTPATIENT SELF-MANAGEMENT TRAINING SERVICES, GROUP SESSION (2 OR Diab manage trn ind/group
G0109 00200 4 MORE), PER 30 MINUTES
G0110 00100 3 NETT PULM-REHAB; EDUCATION/SKILLS TRAINING, INDIVIDUAL Nett pulm-rehab educ; ind
G0111 00100 3 NETT PULM-REHAB; EDUCATION/SKILLS TRAINING, GROUP Nett pulm-rehab educ; group
G0112 00100 3 NETT PULM-REHAB; NUTRITIONAL GUIDANCE, INITIAL Nett;nutrition guid, initial
G0113 00100 3 NETT PULM-REHAB; NUTRITIONAL GUIDANCE, SUBSEQUENT Nett;nutrition guid,subseqnt
G0114 00100 3 NETT PULM-REHAB; PSYCHOSOCIAL CONSULTATION Nett; psychosocial consult
G0115 00100 3 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
• ASC Group Payment Code and Effective Date
• MOG Payment Code, Payment Indicator, and Effective Date
HCPCS File
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• Additional information available:
– Table of Drugs
– Alphanumeric Index
HCPCS Information
• Different publishers, different contents
• Have students use a book from the same publisher
HCPCS Coding Manuals
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• 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
HCPCS Format
• 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
• Pass-Through Items
• Hospital Outpatient Departments
• Outpatient Prospective Payment System
C - Codes
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• Durable Medical Equipment
• DMEPOS Provider
• Physician - prescription
E Codes
• Procedures/Professional Services
• Modifying definition
– Example:
• G0412 – G0415 – unilateral or bilateral
• 27215 – 27218 – unilateral only
G Codes
CPT® Coding Manual
27215
27216
27217
27218
HCPCS Coding Manual
G0412
G0413
G0414
G0415 For
Med
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see
G0
41
2-G
04
15
See
also
, 2
72
15
- 2
72
18
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• PQRS
• Performance Measures
• G8126 – G8977
G Codes
• Drugs administered
* Watch Quantity*
J Codes
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• Temporary Codes
• Not for Medicare claims
Medicare
S Codes
• Commonly used in CPT® Coding Manual – Highlight in HCPCS
• Bracket and label like modifiers • A1 Dressing for one wound
• A2 Dressing for two wounds
• A3 Dressing for three wounds
• A4 Dressing for four wounds
• A5 Dressing for five wounds
• A6 Dressing for six wounds
• A7 Dressing for seven wounds
• A8 Dressing for eight wounds
• A9 Dressing for nine wounds
HCPCS Level II Modifiers
Dre
ssin
gs
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• 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)
HCPCS Level II Modifiers