In medical coding, you may encounter multiple code sets that are very similar to one another. Determining which code group or code to apply in a specific circumstance becomes challenging. This is especially true regarding HCPCS and CPT coding, which present difficulties for professional and newbie coders. Healthcare Common Procedure Coding Systems are referred to as HCPCS. HCPCS Level II codes are often what medical billers and coders mean when they mention HCPCS. Medical supply companies, clinics, and doctors utilize HCPCS codes—part of the national procedure code set—when submitting insurance claims for equipment, medicines, and transportation.
The HCPCS Level II code set demonstrates the most incredible flexibility compared to other medical code sets. For starters, the CMS regularly updates the codes every year depending on input from the parties engaged in medical claims processing. Constant changes are just one of many factors why you should choose a reliable medical billing service, such as RCM Matter, to increase output and enhance data accuracy.
History of HCPCS Codes
HCPCS is a set of mandatory codes developed by the Centres for Medicare and Medicaid Services to ensure proper reporting and documentation of medical services and procedures. The following year, the government mandated the Health Information Portability and Accountability Act (HIPAA), which made it a requirement for healthcare procedures and billing.
Code divisions for HCPCS
Coders report medical procedures to insurance companies like Medicaid and Medicare using the HCPCS code set. There are three tiers in the code set, and they are as follows:
Level 1:
These are mostly the CPT codes issued by the AMA; they are numerical and reflect various medical operations and services.
Level 2:
Alphanumeric codes describe items and services not covered by CPT that physicians do not provide.
Level 3:
This code set, often called HCPCS local codes, is generated by Medicare and Medicaid contractors and private insurers to utilize it in specific contexts and locations. As a result, they lack national recognition.
Codes for Level II HCPCS
Codes at HCPCS Level II are most commonly discussed among medical billers and coders. Wheelchairs, ambulance trips, and medical equipment are all examples of Level II codes because doctors do not provide them but are necessary for patient care. The information regarding the medical equipment utilized during the surgery is separate from the CPT codes, which represent the actual medical procedure. The various medical gear and supplies employed are then given unique HCPCS codes to identify them.
Level II codes are five characters long, like Level I codes, but they are alphanumeric instead than numeric, with a letter filling the first character. Similar to ICD and CPT codes, these codes are arranged numerically and are classified according to the services they provide.
HCPCS subcategories
The HCPCS guide contains the following sections:
- The A codes
transport, equipment for surgery and medicine, other experimental
- The B codes
both parenteral and enteral treatment
- The C codes
short-term hospital OPPS
- The E codes
enduring medical technology
- The G codes
professional services and transient processes
- The H codes
assistance for mental health and substance abuse
- The J codes
Medicines are taken sublingually; chemotherapeutic medicines
- The K codes
Temporary codes for regional transporters of durable medical equipment
- The L codes
orthotic and prosthetic techniques
- The M codes
alternative healthcare options
- The P codes
diagnostic testing and pathology
- The Q codes
Short-term Identifiers (limited use and guidelines specific)
- The R codes
medical imaging and diagnosis
- The S codes
non-Medicare interim national codes
- The T codes
Interim Medicaid agency codes for the state
- The V codes
Services for eyesight and hearing
Using HCPCS for coding
Coders should first consult the HCPCS manual’s directory and table of medicines before attempting to code for administering any drugs or medications. Medication coding is a crucial component of the HCPCS code set, and a drug table is an essential tool for determining the appropriate prescription code.
HCPCS numbers are equivalent to CPT and ICD codes. Each service, medication, and operation on a patient’s medical record is assigned a unique number so that it may be easily and accurately billed. The final step is to look for the correct codes to apply to the rendered services in your HCPCS codebook.
In comparison to CPT coding, HCPCS coding necessitates a greater degree of precision. This is because the code set contains codes for the various weapons systems and medications and their variations, which can get extensive. So, you must adhere closely to the medical report to accurately assign procedure codes.
What are the differences between CPT and HCPCS?
The American Medical Association created and updated the CPT code system to accurately represent surgical, diagnostic, and medical procedures. Current Procedural Terminology CPT stands for Current Procedural Terminology. It allows doctors, patients, coders, and payers to communicate about medical services and procedures. Conversely, the HCPCS codes, derived from the CPT codes, characterize the resources employed in medical provision. If you want to bill Medicaid, Medicare, or any other health insurance program, you must use HCPCS codes. CPT codes are not that private when it comes to the general public.
However, comparing the PT codes to the Relative Value Unit requires a license only available through the AMA. Since HCPCS codes are public documents, anyone with Medicare, Medicaid, or a private insurance plan can quickly look at how they are used to ensure the correct procedures are followed. The Health Insurance Portability and Accountability Act of 1996 required physicians, technicians, and patients to access previously voluntary codes easily.
Conclusion
Similar to how the CPT code set is often updated, the HCPCS set is regularly updated with notifications of new and modified codes. Codes with a strikethrough in HCPCS indicate that they have been removed from that section of the classification system or relocated to another.