Billing and Coding

Custom Student Mr. Teacher ENG 1001-04 4 August 2016

Billing and Coding

Healthcare Common Procedure Coding System (HCPCS) Level II entail nationwide codes used to report supplies and services offered within outpatient locations to Medicaid and Medicare patients that are left out by HCPSC Level I (Current Procedural Terminology -CPT) code. Recent HIPAA federal regulations require regular electronic claims to have Level II regulations. Many big countrywide players, like employee’s compensation financiers, acknowledge HCPCS level II regulations. Local Medicare transporters, business publishers, CMS, or Ingenix provide such codes (Smith, 2003).

Suitable HCPCS level II regulations come before CPT codes regarding Medicare invoicing. However, numerous private players choose National Drug Codes (NDC) or Level I regulations instead of HCPCS Level II regulations, which may confuse medical care experts, thus causing denial of claims. Medical care experts ought to confirm that they are describing the correct regulations to the appropriate players through careful tracking of the billing and reporting needs of specific players. Level II regulations Describes Many heath products, however, such codes do not name real products or endorse them by assigning codes.

Additionally, generation of such codes happens separate from reimbursement issues. Therefore, Level II regulations only serve to indicate the availability of a service or product in the wider health system, as opposed to justifying reimbursement (Smith, 2003). Players individually develop HCPCS Level II regulations’ criteria and rules which vary between players. HCPCS Level II regulations are comprised of a single alphabetical character (from A to V), then 4 digits. Letter ‘I’ is excluded since it may easily be confused with number ‘1’. Every letter group represents one or more areas of comparable services or products.

Every letter group, and code illustrations from specific sections, are fully described on ensuing screens (http://docs. google. com/gview? a=v&q=cache:DIuMS2X_QrgJ:www. ngsmedicare. com/ngsmedi are/DMEMAC/educationandSupport/ToolsandMaterials/SupManual/chapter14. pdf+Level+II+o +HCPCS+applies+and+Medicare&hl=en&gl=ke). A regulations deal with various products and services, particularly tracheostomies, urologicals, and ostomies-related supplies. ‘A’ codes also include Affordable DME, or equipments costing not more than $150, such as nebulizer substitution equipment.

‘A’ code subcategories include: transport services; surgical and medical supplies; and miscellaneous, investigational, and administrative supplies and services. B codes handle parenteral and enteral nutrition services and supplies. B code-reported supplies include: feed supplies; dietary solutions; formulae; and combination pumps. C codes cover services compensated under Medicare’s OPPS -Outpatient Prospective Payment System. They don’t cover services compensated under different Medicare reimbursement systems. Private entities as well use C codes for compensation.

Such codes are mandated by Medicare to report: biological, devices, and drugs qualified for intermediary pass-through imbursements for health facilities; and items categorized within fresh technology Ambulatory Payment Classifications (APC). D codes entail dental regulations. The American Dental Association (ADA) has copyrighted the Current Dental Terminology (CDT). ADA supplies such codes to CMS. E codes document Durable Medical Equipment (DME) like crutches, canes, commodes, walkers, pacemakers, restraints, wheelchairs, hospital beds, and patient lifts.

G codes report professional medical care services and processes such as specialized services being considered for incorporation within the CPT code scheme and provisional procedures. National Medicaid organizations legally mandated to develop separate systems for recognizing psychological health services such as drug therapy and alcohol services use H codes. J codes describe drugs which are not normally self-administered, immunosuppressive and chemotherapy drugs pant solutions, plus other solutions and drugs.

The proper code depends on factors like; dose; and administration route. K codes entail temporary DME, drugs, and supplies codes. They are generated when the relevant existing nationwide codes exclude codes needed to execute medical evaluation policies. Once endorsed for lasting incorporation into HCPCS, such codes become E, J, and A codes. L codes comprise of scoliosis apparatus, prosthetic insertions, orthopedic shoes, plus prosthetic and orphic devices and procedures. M codes cover medical services and they include: M0064; M0075; M0100; M0300; and M0301.

P codes cover laboratory and pathology services and include screening laboratory and pathology services like testing Papanicolaou procedures and serum products (Smith, 2003). Q codes report many supplies and services including provisional cast provisions codes which facilitate splints and casts reimbursement after the modification of Medicare’s compensation technology. Such codes substitute ambiguous splinting and casting supplies’ codes. R codes cover analytic radiology services and document moving of moveable electrocardiogram or x-ray apparatus to patients’ homes, nursing homes, or different facilities.

The Health Insurance Association (HIAA) Blue Cross/Blue Shield Association (BCBSA) uses S codes to document services, supplies, and drugs without countrywide codes, but where private entities require codes for program and policy implementation or processing of claims. Medicaid recognizes such codes; nonetheless, such are not payable. T codes report supplies and services without other stable codes. Medicaid does not accept T codes; however, they may be recognized by private entities. They describe: substance abuse therapy; home and nursing-related services; and training-related processes.

V codes cover supplied and services concerned with hearing, vision, plus speech-language pathology. Vision-related provisions include: lenses; spectacles; and ocular prostheses. Hearing services consist of: hearing analyses; and hearing equipment and supplies. Speech language pathology processes include: modification or repair of supportive communication device or system; and dysphagia, language, and speech screening (http://www. lectureshare. com/download. php? q=HCPCS+overview_021532. pdf&r=doc. J). References Coding:aTheaUseaofaHCPCSaLevelaIIaCodesa. Retrieved August 6th 2009 from http://www.

lectureshare. com/download. php? q=HCPCS+overview_021532. pdf&r=doc. J Jurisdiction B DME MAC Supplier Manual. (June 2009). Level II codes and HCPS modifiers. Retrieved August 6th 2009, from http://docs. google. com/gview? a=v&q=cache:DIuMS2X_QrgJ:www. ngsmedicare. com/ngsmedicare/DMEMAC/educationandSupport/ToolsandMaterials/SupManual/chapter14. pdf+Level+II+of+HCPCS+applies+and+Medicare&hl=en&gl=ke Smith, G. I. (2003). Basic CPT/HCPCS coding. Retrieved August 6th 2009, from http://library. ahima. org/xpedio/groups/public/documents/ahima/bok1_016767. pdf


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  • University/College: University of Arkansas System

  • Type of paper: Thesis/Dissertation Chapter

  • Date: 4 August 2016

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