12 terms

HCPCS Level 2 Coding

STUDY
PLAY
HCPCS
Healthcare Common Procedure Coding System
HCPCS Level 1
Current Procedural Terminology Cpt
The majority of procedures and services are reported using CPT
Durable Medical Equipment (DME)
is defined by Medicare as equipment that can withstand repeated use, is primarily used to serve a medical purpose, is used in the patient's home, and would not be used in the absence of illness or injury
DME Medicare administrative contractors
DME MACS
When an appropriate HCPCS Level 2 code exists:
it is often assigned instead of a CPT code (with the same or similar code description) for Medicare accounts for some state Medicaid systems. (Other payers may not require the reporting of HCPCS level 2 codes instead of CPT codes, so coders should check with individual payers to determine their policies.
Medicare
G code
Medicaid
H code
HCPCS is not a reimbursent methodolgy or system,
it is important to understand that just because codes exist for certain products or services, coverage,(ex. payment) is not guaranteed
Appendix 2
has the modifiers
Jo120-j8499
Drugs Administered Other Than Oral Method
(Maybe used in combo with cpt)
Certificate of Medical Necessity (CMN)
For certain items or services DMEPOS dealer must receive a signed CMN from the treating physician before submitting a claim to Medicare.
Some services must be reported by assigning both a CPT and a HCPCS code.
The most common scenario uses the CPT code for administration of an infection and the HCPCS level 2 code to identify the medication administered.