HCPCS stands for Healthcare common Procedure Coding System, and is a standardized set of code that is used extensively by healthcare professionals and insurance providers in order to chalk up the insurance claims. The codes and resources provided by HCPCS offers and orderly method to assimilate and calculate the insurance, thus making it easier for everyone involved in dealing with insurance claims.
HCPCS was developed by the Centers for Medicare and Medicaid (CMS) to perform similar functions as the CPT- i.e. for reporting and recording medical processes and services. HCPCS was not deemed mandatory until 1996; however, the Government passed the Health Information Portability and Accountability Act (HIPAA), which made HCPCS mandatory to represent procedures pertaining to Medicare, Medicaid, and other third-party payers.
Two levels of HCPCS code
HCPCS has two levels of coding, aptly named Level II and Level I. both Level II and Level I codes are five characters long, and comprise of alphanumeric characters. HCPCS codes are divided into a number of sections, each of them corresponding the different medical procedures and services that a medical professional can administer to the patients.
Level II is a code set that is used by health care professional and associated billers & coders to draw the insurance claims. It represents medical supplies, medical goods, non physician services and other services that are not covered under Level I. Here, the non physician services include ambulance services, durable medical equipment, prosthetics, orthodontics supplies (DMEPOS), when they are used/ administered outside a physician’s office.
Level I is commonly referred to as Current Procedural Terminology (CPT) codes, and is maintained by the American Medical Association. CMS reviews and amends the guidelines that the AMA uses to craft HCPCS Level I, thus ensuring that a uniform is followed throughout the nation. Currently this system has been expanded to include the claims submitted by the Outpatient Prospective Payment System (OPPS) and the skilled nursing facilities (SNFs).
CPT and HCPCS codes
Both CPT and HCPCS look very similar to an untrained eye, especially since the Level I of HCPCS entails CPT codes. Only a trained biller will know the subtle nuances that differentiate the two. Being able to notice the differences in the two is important as it directly impacts health care reimbursement.
It is thus the responsibility of the billers and coders to ensure that the health care data is entered and maintained properly. Learning about these intricacies requires professional training and experience in order to be able to deliver error free billing services.
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- HCPCS CODES. (2017). Retrieved January 27, 2017, from www.medicalbillingandcoding.org: http://www.medicalbillingandcoding.org/hcpcs-codes/
- HCPCS Level II Coding Process & Criteria. (2017). Retrieved January 27, 2017, from www.cms.gov: https://www.cms.gov/Medicare/Coding/MedHCPCSGenInfo/HCPCSCODINGPROCESS.html
- What is HCPCS? (2017). Retrieved January 27, 2017, from www.aapc.com: https://www.aapc.com/resources/medical-coding/hcpcs.aspx