Description
Please post initial responses and peer responses to the following discussion questions listed below:CPT coding is only one portion of a two-part coding system called HCPCS (pronounced “hick-picks”), which stands for Healthcare Common Procedure Coding System. What is included in HCPCS? More than 50 alphabetical modifiers are available for assignment, to add further specificity to the five-digit national code. CPT and HCPCS modifiers are used with both HCPCS and CPT codes. What are some examples of how modifiers can be used? (Tips: Modifiers can be used to specify the service provider, the anatomic site, etc.)A coder going through medical documentation finds that only the brand names of drugs are listed. What course of action should he or she take to ensure assignment of the proper HCPCS code? (Tips: J codes are reported to identify the drugs administered and the dosages, think about using a drug reference book.)It is essential that for each discussion questions that you write the entire question and label it with the correct number clearly for each question chosen.
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Module 6-Question 1-Debra Rabbani
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Debra Rabbani posted Sep 27, 2023 2:12 AM
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Question: 1-CPT coding is only one portion of a two-part
coding system called HCPCS (pronounced “hick-picks”), which
stands for Healthcare Common Procedure Coding System.
What is included in HCPCS? More than 50 alphabetical
modifiers are available for assignment, to add further specificity
to the five-digit national code. CPT and HCPCS modifiers are
used with both HCPCS and CPT codes. What are some
examples of how modifiers can be used? (Tips: Modifiers can be
used to specify the service provider, the anatomic site, etc.
Answer: Modifiers are used with both coding platforms (CPT
and HCPCS). The HCPCS provides modifiers for procedures
codes for CPT coding. HCPCS is a collection of standardized
codes that represent medical procedures, supplies, products,
and services. The codes are used to facilitate the processing of
health insurance claims by Medicare and other insurers. HCPCS
is divided into two subsystems, Level I and Level II.
These modifiers provide additional data about medical services,
procedures, or supplies without changing the code meanings.
HCPCS modifiers allow for greater accuracy in coding and can
be extremely important in the reimbursement process. The
correct modifier to use is determined by payor preference.
There can be instances where a CPT code is further defined by
a HCPCS modifier, for example, to describe the side of the
body the procedure is performed on such as left (modifier -LT)
or right (modifier -RT).HCPCS modifiers are two characters
(numbers or letters) added to the end of an HCPCS Level I or
Level II code.
Modifiers cover a broad scope of information. While most of
the codes correspond to parts of the body, there are also
modifiers for ambulance services and mammograms. If you look
at the full list of HCPCS modifiers, you’ll also find modifiers that
describe everything from the Medicare eligibility of a procedure
to the number of wounds dressed on a single patient.
As with CPT codes, we always want to use modifiers for
functionality first, and information second. That is, you’ll want
to list the HCPCS modifier that directly affects reimbursement
first. Remember that while certain coding forms provide space
for multiple modifiers, payers don’t always look at modifiers
listed after the first two.
Note that certain HCPCS modifiers don’t “agree” with certain
CPT modifiers. The most obvious example of this would be CPT
modifier -50 and the HCPCS modifiers –LT and –RT. These
modifiers are mutually exclusive: CPT modifier -50 describes a
bilateral procedure, while HCPCS modifiers –LT and –RT
describe which side of the body a procedure is performed on.
Let’s look at a simplified example of an HCPCS modifier in
action.
Example 1: A patient is suffering from bronchitis and asthma.
This patient has difficulty breathing and calls his doctor. The
doctor advises the patient to go directly to the emergency
room. The doctor arranges with the hospital, which in this case
would be the healthcare provider, to pick up the patient in an
ambulance with basic life support systems, or BLS.
To code this procedure on a claim, we’d look at the A-codes of
HCPCS, where the ambulance codes reside. There we’d
find A0428, for “Ambulance service, basic life support, nonemergency transport.” That’s our base HCPCS code.
Since, however, the ambulance was provided by the healthcare
provider and not, say, called in via 911, we should add a
modifier to explain this. This may seem like splitting hairs, but
how an ambulance is called can greatly affect the amount of
money owed for a procedure.
In this case, we’d look for a modifier that pertains to ambulance
service. We’d find the –QN modifier, for “Ambulance service
furnished directly by a provider of services”—in other words,
the hospital, the service provider, sent the ambulance over to
pick up our patient.
We’d end up with this code: A0428-QN for a basic life support
ambulance service, non-emergency transport, furnished by the
provider of services.
Example 2: This example uses a combination of CPT codes, CPT
modifiers and HCPCS modifiers.
A patient requires the drainage of a large, felon abscess on the
tip of the middle finger of his left hand. A “felon” abscess is a
complicated infection of the pulp on the distal, or last, phalanx
of the hand. During the procedure, however, the patient
becomes agitated, and the doctor decides to discontinue the
procedure.
If we’re coding this procedure, we’d first look at the procedure
performed. This is a procedure done to a patient, so we’re
probably going to find it in the CPT codebook. It’s also a
surgical procedure, so we’d find it in the Surgery section of the
codebook. Specifically, this is an incision—its drainage made via
a cut to the skin.
Once in the surgery section, we’d flip to the musculoskeletal
subsection and find the Hand and Fingers field of codes. There
we’d find the codes for incision and see that there are two
codes for drainage of a finger abscess: the parent code 26010
for “drainage of finger abscess; simple” and the indented code
26011 for “drainage of finger abscess; complicated (e.g, felon).”
The abscess we’re draining is complicated—it’s even listed in
the code as an example of a complicated abscess. So, we’d
select the indented code and put 26011 as our base code.
Now we’d need to look at the additional information. What’s
the more important code for reimbursement: the place on the
hand where the procedure took place, or the fact that the
procedure was discontinued? In this case, it’d be
the discontinued procedure.
We’d add the CPT modifier -53 for discontinued procedure,
and then we’d look at the HCPCS modifiers for where on the
body the procedure was performed. If you recall, some of the
HCPCS modifiers we listed earlier have to do with parts of the
hand. We’ll look at these modifiers and find the one that fits
our need: F2, for “left hand, third digit.”
So, our code would look like this: CPT code 26011, CPT
modifier -53 and HCPSC F2: a discontinued drainage of a
complicated abscess on the third digit of the left hand.
I hope I provided two concrete examples of how to use HCPCS
codes independently as well as combined with CPT codes and
CPT modifiers.
Brand Names
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Melissa Berkel posted Sep 26, 2023 8:39 PM
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2. A coder going through medical documentation finds that only
the brand names of drugs are listed. What course of action
should he or she take to ensure assignment of the proper
HCPCS code? (Tips: J codes are reported to identify the drugs
administered and the dosages, think about using a drug
reference book.)
J codes are used to report drugs that are not given orally. This
would include infusions, IM and SQ injections, inhalants and
others. In a hospital setting you will find a formulary that is
already programmed into the EMR system. It is usually based
on a database, such as First Databank, that maintains and
updates drug lists. The hospital formulary will cross reference
the drug with the J code and charge description master (CDM)
file. There would not generally be need to look much up to
reference generic versus brand, especially if the health system
is using bedside scanning. You still have to keep an eye on your
charge mapping, billing units, and make sure new NDC’s are
entered correctly.
In the case of this discussion question, I would advise that they
move away from brand names as a whole. The pharmacy should
be operating on generic names- but this instance seems like
maybe it is a small office or provider that charts differently than
a health system would. The coder should cross reference these
drugs to identify the correct Jcodes to use. There are multiple
resources to verity the generic name of a brand drug such as
the NIH website, DailyMed, or the Lexicomp database if the
provider/organization is subscribed. Some companies like
Optum have a Coder’s Desk Reference. I find DailyMed to be
more user friendly than PDR.
Using the national codes table of drugs in conjunction with a
solid reference point like the ones I have listed will help the
coder select the correct Jcode. It is imperative that the correct
code is selected. If there are any questions or doubts the coder
should contact the provider. (Buck & Koesterman, 2022)
References
Buck, C., & Koesterman, J. (2022). Chapter 9. In C. Buck, & J.
Koesterman, Buck’s Step by Step Mecial Coding 2022. Elsevier.
Module 6 Discussion Question 2
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McKenzie Rogman posted Sep 26, 2023 10:15 PM
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2. A coder going through medical documentation finds that only
the brand names of drugs are listed. What course of action
should he or she take to ensure assignment of the proper
HCPCS code? (Tips: J codes are reported to identify the drugs
administered and the dosages, think about using a drug
reference book.)
To ensure the assignment of the proper HCPCS code, the coder
should definitely be updated on the annual updates to ensure
the appropriate codes are being reported and old codes are not
being used out of habit. Depending on the situation, the brand
name may be able to be used or the coder may have to look up
the generic name of the drug if they are unsure about the brand
name. I think physicians and other medical staff should make
things as easy as possible for the coders because they have
such a difficult job to do as it is. Each professional should want
to help someone else out.
The coder could also use the HCPCS Level II codebook’s, J
codes, that are specifically used to help the coder if they are
only given the brand name of the drug on the medical
document. These codes also help identify injectable drugs that
cannot ordinarily be self administered, chemotherapy drugs,
and also some kinds of orally given drugs.
These codes can be used in any setting, so inpatient,
outpatient, doctor’s office, or infusion center all can use these. I
think it is extremely important for coders to be familiar with
some of the more common drugs that are constantly stated or
appear on the medical document. If they are not familiar with a
certain one or two, it would not hurt to look it up and then be
familiar with it next time.
Module 6 Question 1
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Jill Heflin posted Sep 26, 2023 4:47 PM
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Healthcare Common Procedure Coding (HCPCS) is a group of
medical codes that represents procedures, supplies, products,
and services in an outpatient setting. HCPCS is categorized into
two levels: Level I and Level II. Level I HCPCS code set include
the CPT codes and is the primary coding system used in the
outpatient setting to code professional services. Level II HCPCS
is also known as National Codes, and this explains “what the
provider used” to treat the patient. The National Codes
represent drugs, supplies, nonphysician services that are not
listed in the Level I codes, such as, durable medical equipment,
drugs, prosthetics and orthotics.
Modifiers are added to the national codes to further expand the
description of the code. The modifiers are used to specify a
service provider, the anatomic site, or adds specificity to
durable medical equipment. A modifier is used to describe an
anatomic site when the body part has a mirror image, such as,
modifiers for the eyelids are E1-E4. This can be further
demonstrated in an example of an ophthalmologist performing
a removal of an eyelash to the upper left eyelid using the EI
modifier to describe the upper left eyelid. The medical coder
would use the HCPCS code with modifier of 67820-E1. The
modifier AE would be an example of a service provider when
the services are provided by a nutrition professional such as a
registered dietician. Modifiers are an important aspect in
medical coding of HCPCS national codes as it enables the
medical coder to code to the highest accuracy and specificity.
CPT Coding Modifiers
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Melissa Berkel posted Sep 26, 2023 8:04 PM
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1. CPT coding is only one portion of a two-part coding
system called HCPCS (pronounced “hick-picks”), which
stands for Healthcare Common Procedure Coding System.
What is included in HCPCS?
-More than 50 alphabetical modifiers are available for
assignment, to add further specificity to the five-digit national
code. CPT and HCPCS modifiers are used with both HCPCS
and CPT codes. What are
some examples of how
modifiers can be used? (Tips: Modifiers can be used to specify
the service provider, the anatomic site, etc.)
The Healthcare Common Procedure Coding System (HCPCS)
are standardized codes that are used for procedures, supplies,
products and services. Because these codes are standardized,
they help Medicare and other insurers process claims more
efficiently. (NIH)
There are two subcategories of HCPCS. The first is Level I. In
HCPCS the Level I codes are Current Procedural Terminology
codes (CPT or HCPT). (NIH) There is a manual of CPT codes
that is maintained by the AMA. These Level I CPT codes are put
to use in the outpatient setting. They correspond with services
provided to patients. (Buck & Koesterman, 2022)
Level II codes are considered “national codes”. Revised
quarterly, these are maintained by the CMS, Health Insurance
Association of America, and the Blue Cross Blue Shield
Association. These codes are used to encompass things that
Level I does not, and can even override a CPT code. Level II
codes cover products, supplies, physicians and non-physician
services. (Buck & Koesterman, 2022) Current Dental
Terminology (HCDT) codes are also included in Level II
codes. (NIH)
The national codes are further categorized by a lettering system
to indicate the category for the type of service or procedure.
For example, Level II codes that start with the letter “P” are
pertaining to lab services.
In addition to the two code levels, the letter grouping, and
miscellaneous codes there are also modifiers. Sometimes when
coding for a procedure or equipment a payor will ask for
modifiers to describe the encounter in more detail. There are
over 50 modifiers a coder can use to add more detail, or a
payor can require for processing. For CPT codes the modifiers
are numbers, and for the HCPCS Level II codes the modifiers
are a letter combination or alphanumeric combination.
Modifiers can indicate the provider, the anatomic location, and
the durable medical equipment (DME) details. As an example, if
we were to use modifier LL, we would indicated that the DME
the patient has is a rental/lease. Or, if we use modifier NU it
would indicate new equipment. We can get even more specific
with a modifier like E2 that indicates the lower left eye lid. This
would be a good modifier for V codes that pertain to vision.
(Buck & Koesterman, 2022)
References
Buck, C., & Koesterman, J. (2022). Chapter 9. In C. Buck, & J.
Koesterman, Buck’s Step by Step Mecial Coding 2022. Elsevier.
NIH. (n.d.). Unified Medical Language System (UMLS).
Retrieved from
NIH.gov: https://www.nlm.nih.gov/research/umls/sourcereleas
edocs/current/HCPCS/index.html
Module 6 Question 1
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Cami Williams posted Sep 26, 2023 3:28 PM
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1. CPT coding is only one portion of a two-part coding
system called HCPCS (pronounced “hick-picks”), which
stands for Healthcare Common Procedure Coding System.
What is included in HCPCS?
o
HCPCS is a coding system that includes CPT coding
as well as the services which are not coded by CPT.
These services are divided into 2 levels: level 1 and
level 2.
▪
▪
Level 1 includes CPT codes that are developed,
maintained, and copyrighted by the American
Medical Association (AMA). It is the primary
coding system used in the outpatient setting to
code professional services provided to
patients. It includes identifying services and
procedures.
Level 2 (National Codes) are approved and
maintained jointly by the Alpha Numeric
Workgroup, consisting of the Centers for
Medicare and Medicaid Services (CMS), the
Health Insurance Association of America, and
the Blue Cross Blue Shield Association. Level 2
codes are five-character alpha numeric codes
representing physician and non-physician
services, products, and supplies that are not
represented in the Level 1 codes. In some
instances, Medicare requires the use of a Level
2 HCPCS code to override an already existing
CPT code.
2. More than 50 alphabetical modifiers are available for
assignment, to add further specificity to the five-digit
national code. CPT and HCPCS modifiers are used with
both HCPCS and CPT codes. What are some examples of
how modifiers can be used? (Tips: Modifiers can be used
to specify the service provider, the anatomic site, etc.)
o Modifiers inform third-party payers of
circumstances that may affect the way payment is
made. Modifiers indicate the following types of
information: altered service, bilateral procedure,
multiple procedures, professional part of the
service/procedure only, and more than one
physician/surgeon.
▪ Modifier -22 indicates that the service was
greater than usual. An example would be
trauma that was extensive enough to
complicate the procedure requiring more
effort than usual by the physician.
▪ Modifier -26 is used to designate the physician
component of a procedure, as well as the
technical component. For example, a physician
orders an ultrasound, which requires the
technician and machine to perform the
ultrasound, as well as a radiologist to interpret
the ultrasound.
Module 6 Q2
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Katie Corcoran posted Sep 26, 2023 7:47 PM
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1. A coder going through medical documentation finds that
only the brand names of drugs are listed. What course of
action should he or she take to ensure assignment of the
proper HCPCS code(Tips: J codes are reported to identify
the drugs administered and the dosages, think about using
a drug reference book.)
When coding for drugs the coder needs to make sure that they
are being very diligent about making sure that what they are
coding is correct when it comes to the dosage of the drugs that
are given and they are using generic or brand name. This is
because there could be a different code sequence. The use of J
codes are to identify the drug that was administered and the
dosage’s that were given. The National Codes has a table of
drugs to help direct the coder to the drug title and the code
that goes with it.
The use of J codes usually use the generic names of the drugs
but there are some cases that a drug is only know by the brand
name or the trade name then they will be “directed to the
generic name of the drug and then to the associated J or Q
code by a cross-reference system within the table.” (232). Then
then Physicians’ Desk Reference (PDR) would contain the
prescribing information on the prescribing information on the
drug and lists the drug by brand and generic names.
Overall coding between generic and brand name can be very
confusing and frustrating for the coding so I would encourage
them to consult CMS system for they are struggling to find the
code that they are looking for. Another thing that could be
helpful is using the HCPCS system because the information on
there is constantly being updated so that could be useful in that
situation. Also if you are conducting regular audit’s of your
coders just to make sure that they are keeping up to the
standard’s when it comes to be accurate.
References
Elsevier. (2021). Buck’s Step-By-Step Medical Coding, 2022
Edition. Saunders.
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