Chapter 1 HCPCS Introduction Flashcards
What does HCPCS stand for?
Healthcare Common Procedure Coding System
Who developed HCPCS?
Centers for Medicare and Medicaid Services (CMS)
What is HCPCS used for?
Injectable drugs, devices, supplies, equipment
Two-part system developed by CMS to standardize the coding system used to process Medicare claims
Used for all services
Surgical, medical, supplies, materials, injections
HCPCS
CPT Codes: Majority of _____ can be coded using CPT
Level 1 of HCPCS
National Codes: Developed by CMS to identify other services not in CPT
Level 2 of HCPCS
Supplies
Such as wheelchairs, hearing aid batteries and crutches
Injection codes
Identify actual substances, such as penicillin
Other
Dental, chiropractic, vision, orthotics
National Level II Codes
S8451 Splint, prefabricated, wrist or ankle
HCPCS Level II Code
Diagnosis only Report at highest level of specificity Explains reason for encounter Linked to procedures for professional billing Payers can deny payment based on reason Published lists of unapproved diagnoses
ICD-10-CM: Ambulatory Care
__________ diagnosis codes explains WHY patient seeking services
ICD-10-CM
_________ codes explains WHAT services were performed
HCPCS
Facility and physician
- ICD-10-CM for diagnoses
- HCPCS for procedures
Medicare Required Codes: Ambulatory
Facility (hospital) - ICD-10-CM for diagnoses - ICD-10-PCS for procedures Physician services - ICD-10-CM for diagnoses - HCPCS for procedures
Medicare Required Codes: Inpatients
Used by physicians and free standing ASCs
Diagnosis and procedure codes must be linked
CMS-1500
Used primarily by hospitals (inpatient and outpatient)
CMS-1450 or UB-04
