HCPCS Common Coding Questions

Introduction

The Healthcare Common Procedural Coding System (HCPCS) is a system to classify items, supplies, and services used in health care. The United States Department of Health and Human Services specifies the codes that are included in the HCPCS. There are three levels of codes: Level I, Level II, and Level III. Each level has a different purpose for use in billing purposes by hospitals, clinics, physicians’ offices, or other providers who provide healthcare services.

What is the HCPCS level II?

Level II codes are used to pay for services performed by physicians, surgeons, and other practitioners in hospitals. They also cover services provided in nursing homes, rehabilitation institutions, or other facilities or locations.

Level II CPT codes may be reported either by the facility or by the provider who performed the service. Level II HCPCS codes are used to reimburse healthcare providers for professional services rendered outside of an outpatient setting to patients that require hospital-based care due to a chronic medical condition or injury.

What do the letters and numbers in the HCPCS code stand for?

Each HCPCS code consists of five parts. The first three letters and the last four digits are known as the procedure code, which refers to the procedure that was performed during your stay at a hospital or other facility. The middle two digits are an ‘office’ code that specifies what office it was performed in, such as an outpatient surgery center or emergency room.

The “diagnostic” portion (the first three letters) can be surprising: for example, CPT codes for many procedures use different letter combinations to denote whether they were performed in-office or out-of-hospital—so if you have gallbladder surgery done one time and another time with laparoscopic assistance (two separate surgeries), both would receive the same diagnosis code despite being vastly different procedures!

What is a CPT code?

CPT codes are used by health care providers to bill for their services. Additionally, CPT codes can be used as part of the process to determine what an insurance company will or will not pay for. A medical claim that is submitted with a specific CPT code may result in reimbursement from the insurer, depending on the complexity and level of care provided by the provider using that code.

How does the American Medical Association affect coding for medical services?

The American Medical Association (AMA) is a professional organization for physicians, and it publishes the Current Procedural Terminology (CPT) code book. The CPT coders are responsible for assigning CPT codes to medical services. They use this codebook as a reference when doing so. AMA provides guidance on medical coding in a variety of ways, including:

●    A Code Maintenance Committee that considers how new diagnoses should be classified and what they should be called

●    A Coding Policy and Compliance Committee that ensures doctors only charge their patient’s accurate amounts for services performed by them

Where can I find more information about the Healthcare Common Procedure Coding System (HCPCS)?

The Healthcare Common Procedure Coding System (HCPCS) is used to code medical services performed by physicians and non-physician providers. The codes are divided into two principal subsystems, referred to as level I and level II of the HCPCS. Physicians usually use level I codes because they apply to all patients. Non-physician providers may not use these codes because they do not apply across all patient populations or payer universes. The American Medical Association created a toolkit for coding questions related to durable medical equipment, prosthetics, orthotics, and other supplies (DMEPOS). 

The Healthcare Common Procedural Coding System (HCPCS) is a system to classify items, supplies, and services used in health care.

The Healthcare Common Procedural Coding System (HCPCS) is a system to classify items, supplies, and services used in health care. It is an extensive classification that includes not only procedures but also supplies and equipment ordered by the physician. Level I of HCPCS has been in existence since 1968 while level II was established in 1992.

The HCPCS classifies all Medicare procedure codes into ten categories: 0 – Miscellaneous Services; 1 – Professional Services; 2 – Anesthesiology; 3 – Radiology; 4 – Pathology/Laboratory Medicine; 5 – Surgery/Laparoscopic Surgery; 6 – Obstetrics/Gynecology; 7 – Internal Medicine (allopath); 8 – Cardiovascular Disease Diagnostic Related Groupings (CVD-DRG); 9 Endocrinology Test Codes

Conclusion

We hope you have found this article helpful and that it has given you some insight into the world of HCPCS coding. If you have any questions or comments, please let us know!