HCPCS Codes in Healthcare BPO

HCPCS is the acronym for Healthcare Common Procedure Coding System. The "Hick Picks" as it is popularly called, refer to a set of healthcare procedure codes that are based on the American Medical Association's (AMA) CPT (Current Procedural Terminology) Codes. HCPCS level 2 codes were developed to further help define CPT-4 codes.

Every year, in the United States of America, over five billion claims are processed for payment by healthcare insurers, like the Medicare, Medicaid and other healthcare insurers. With the help of HCPCS level ii codes, such claims are processed in a standardized fashion across the US. Today, HCPCS procedure codes are extensively used by healthcare insurers and closely examined by the CMS (Center for Medicare and Medicaid Services).

The History of HCPCS Medical Codes

The Healthcare Common Procedure Coding System was founded in the year 1978 with an aim to provide a standard coding system for describing healthcare BPO. Such a coding system was necessary for Medicaid, Medicare and other such healthcare insurance programs to make sure that insurance claims were consistently processed in an orderly manner. Earlier, the use of the HCPCS codes in healthcare was optional, but with the implementation of HIPAA in 1996, the use of level ii HCPCS codes in healthcare became mandatory.

What are HCPCS Codes?

Level I HCPCS Medicare codes (CPT) did not represent certain services like medical supplies, durable medical equipment and non-physician services. All these and other set of services like ambulance services, orthotics, prosthetics, etc. are represented by HCPCS level 2 codes (five-character alpha-numeric codes). It is also the official code set for chemotherapy drugs and outpatient hospital care. The American Dental Association (ADA) and the Blue Cross Blue Shield Association also use the HCPCS Level II codes.

Levels of HCPCS Codes in Healthcare:

1. Level I codes are numeric in nature and mainly consists of current procedural terminology (CPT) by the AMA (American Medical Association). These codes are identical to CTP codes.
2. Level II codes are alphanumeric and mainly include non-physician related services like prosthetic devises or ambulance services. These codes represent services / supplies that are not covered by Level I codes. Level II HCPCS codes are used by ambulance suppliers, medical equipment suppliers, etc.

How Are HCPCS Medical Codes Used?

With the help of HCPCS procedure codes, numbers are assigned to each service that a physician may offer to a Medicare patient; be it surgical, medical or diagnostic. HCPCS Medicare ensures uniformity by ensuring that everyone uses the same HCPCS Medicare codes for the same medical services. For example, no matter what physician a Medicare patient visits for an allergy injection (HCPCS Code no 95115) that physician will be paid the same amount that another physician in that same region would be paid.

The HCPCS in medical coding system is divided into two sub-systems, to help simplify and organize zillions of medical claims processed for payment every year in the United States. Computer data is used to correctly code and categorize medical information. HCPCS level 2 codes are updated on a regular basis, as and when new medical services and procedures are developed. Feedback about level ii HCPCS codes is also taken from manufactures, providers, speciality societies, vendors, the ADA, and the Blue Cross amongst others.

Examples of HCPCS in Healthcare

The HCPCS system is divided into categories like Dental procedures, Vision Services, Ambulance Services and Injections amongst others. HCPCS codes consist of five digit codes that are alphanumeric (a combination of numbers with alphabets). When compared to CPT codes, HCPCS codes are split more generally. For example, letter A would refer to ambulance services, while letter D would refer to dental services and letter J would refer to injections. HCPCS medical codes are also very specific and detailed. For example, HCPCS code no 12002 may specifically refer to the stitching up of a one-inch bruise on a Medicare patient's arm.

What are HCPCS Codes Lookups?

HCPCS codes lookups are done to understand what service/procedure a HCPCS code represents and how much Medicare pays to the doctor/facility in a particular area for a particular service. You can also learn about the average amount paid across the United States for a particular HCPCS code. A HCPCS lookup is usually done to find out three things, which include, the description of each HCPCS code, the Geographic Practice Cost (GPCI) and the Relative Value Amount (RVU). All these three are then put together to get the Physician Fee Schedule.

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