Healthcare Common Procedure Coding System

February 12th, 2009 - Codapedia Editor
Categories:   Coding   HCPCS Coding  

Healthcare Common Procedure Coding System (HCPCS) are a set of standardized codes which health care providers use to report services to insurance companies. 

The first set, CPT® (Level I HCPCS codes,) are owned, developed and copyrighted by the American Medical Association.  These codes are published annually in their book, Common Procedural Terminology.  It is critical for physician offices to buy a new CPT® book each year, and to review the new codes, deleted codes, changes to definitions and editorial comments associated with the services they provide.  Changes to the CPT® book are the result of an AMA committee.  See the CPT® book for instructions about submitting requests for new services.

New CPT® codes are described in detail, along with clinical examples, in the AMA's annual publication CPT® Changes: an Insider's View.  It is well worth the price.  The AMA also publishes a newsletter, the CPT® Assistant.  Back issues are available for purchase online or on a CD.

Level II HCPCS codes are in the HCPCS book, developed and maintained by CMS. Level II HCPCS codes are five digit, alpha-numeric codes.  Although few physician offices try to get away with not buying a new CPT® book, many offices think they do not need a HCPCS book every year.   The are wrong.

Level II HCPCS codes do include codes and services not performed by physicians, such as ambulance billing and durable medical equipment, which many practices do not bill for. But, the book also includes temporary codes developed by CMS, medication codes and codes for preventive medicine services, that must be used by physicians when billing Medicare for those services.

Physician offices can lose significant revenue by not having the up to date codes for medications, with the correct units.  Be careful about billing for units of medications.  The nurse or medical assistant who gives the medication should be familiar with the HCPCS book, how to look up dosages, and indicate the correct dosage on the encounter form.

There are many supplies described in the HCPCS book. In general, physicians are not paid by Medicare for supplies.  With the development of the Resource Based Relative Value System (RBRVS) CMS has valued the cost of supplies into office visits and inidividual procedures.  Some private payers may still pay for supplies separately, but they are in the minority.


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