Question

1. Choose a DMEPOS service or supply that would be reported from HCPCS Level II

2. Explain, in your own words, what details you need to determine an accurate HCPCS Level II code

3. Create a scenario illustrating a physician providing this procedure. Include the diagnosis for which this procedure would be medically necessary.

4. Report the accurate HCPCS Level II code or codes. Include any necessary modifiers.

Answer 1

Healthcare Common Procedure Coding System (HCPCS) is a standardized code system necessary for medical providers to submit healthcare claims to Medicare and other health insurances in a consistent and orderly manner. HCPCS comprises two medical code sets, HCPCS Level I and HCPCS Level II.

HCPCS Level I consists of the Current Procedural Terminology (CPT code set and is used to submit medical claims to payers for procedures and services performed by physicians, nonphysician practitioners, hospitals, laboratories, and outpatient facilities.

HCPCS Level II is the national procedure code set for healthcare practitioners, providers, and medical equipment suppliers when filing health plan claims for medical devices, supplies, medications, transportation services, and other items and services.

When medical coders and billers talk about HCPCS codes, they're referring to HCPCS Level II codes. When they talk about CPT coding, they’re actually referring to HCPCS Level I.

The history of HCPCS coding began in 1978 when the federal government created this coding system to standardize the reporting of medical services to the federal government for reimbursement. The HCPCS system, however, underwent several changes before adoption by commercial payers, which was eventually mandated by HIPAA in 1996.

Prior to the advent of procedure coding, providers submitted written descriptions of the services they performed to payers for reimbursement. This proved inefficient, in that 100 providers could report the same service with 100 different descriptions.