HCPCS Codes: All That You Need to Know
HCPCS Codes, Healthcare Common Procedure Coding System numbers, are the medical codes used by Medicare. The HCPCS is monitored by CMS, the Centers for Medicare and Medicaid Services. Developed by the AMA or the American Medical Association, the codes are based on the CPT or Procedural Technology codes. Each year, health care insurers process over 5 billion claims for payment. To ensure that these claims are processed in an orderly and consistent manner, standardized coding systems are followed throughout.
HCPCS codes are numbers assigned to every task and service a medical practitioner provides to a Medicare patient. The fact that everyone uses the same codes to mean the same thing, they ensure uniformity. For example, when a patient visits for an allergy injection, the doctor will be paid by Medicare the same amount another doctor in that same geographic region would get.
There are two sets of HCPCS codes. The first set is called HCPCS Level I, which is based on and identical to the CPT codes. The second set of codes are called the Level II HCPCS codes were initially developed by CMS to report services, supplies or procedures which were not present in the Level I CPT codes. The Level II codes are used by the medical suppliers other than physicians, for example ambulance services or durable medical equipment. Products are classified based on similarities in function and exhibit significant therapeutic distinctions from other products.
Where a HCPCS code is present in the chargemaster, it gets easy and less time is required in coding claims at the back end, but you need to take care that appropriate charge codes are used. Direct coding of HCPCS codes into the chargemaster is referred to as static coding. Many ancillary procedures such as laboratory or radiology procedures can be coded statically, that is HCPCS codes are placed in the chargemaster.
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PublicHealth257B Fall09 Lecture 1
