Coding

Two-digit numeric or alpha code used with another code to indicate that a service or procedure has been altered. For example, -25 indicates a service that is separately identified from other services provided during the same encounter.

The classification of morbidity and mortality information for statistical purposes and for the indexing of hospital records by disease and operations for data storage and retrieval. A numeric classification of description of diseases, injuries, and causes of death. Medicare, Medicaid, and health plans require providers to include a diagnosis and procedure code or codes on each claim submitted for payment.

These codes are grouped together to determine the MS-DRG assignment.

Hospital must report both ICD-9 diagnosis and procedure codes. Physicians report only ICD-9 diagnosis codes and use CPT-4 codes to report services and procedures.

The proposed revised classification of morbidity and mortality information for statistical purposes and for the indexing of hospital records by disease and operations for data storage and retrieval. ICD 10th revision contains a significant increase in codes over ICD-9, including the addition of a sixth character, codes relevant to ambulatory and managed care encounters, expanded injury codes and greater specificity in code assignment.

HCPCS coding is the standard acronym for Healthcare Common Procedure Coding System (HCPCS). The system is designed to help simplify and organize the billions of medical claims that are processed for payment each year in the United States. Knowledge of HCPCS coding is a specialty in medical administration.

HCPCS coding is broken down into two primary subsystems, which are referred to as level I and level II. Level I HCPCS coding includes the Current Procedural Terminology (CPT) codes, which are a numerical coding system maintained by the American Medical Society. CPT codes numerically identify medical services and procedures.

HCPCS coding level II was established in the 1980s as a way to assign codes to services, supplies, and procedures not included in the CPT coding system, but still covered by and billable to a health plan. Level II HCPCS coding consists of a single letter followed by four numbers instead of the standard 5 number CPT code.

As of 2003, HCPCS level III codes became established. Rather than being nationally accepted, the level III codes became considered local codes that established a code for items or services not included in either of the two previous levels. As the healthcare industry continues to advance, the need to refine and expand the HCPCS coding continues. This allows health plans and providers to determine billing and coverage. Each time a new procedure or service is developed, a code that identifies it must also be established.

This is a standard, universal code that is applied to medical procedures and services for the purpose of patient records. CPT was developed by the American Medical Association (AMA) in 1966. CPT codes are uniform codes that translate the same for doctors, hospitals, patients, health plans, and other third parties.

CPT coding is like a language for those who work in the medical field. A CPT code is a string of numbers, usually five, that indicates a service or procedure. The AMA approves all CPT codes and updates them annually. CPT coding is an intricate and very specific procedure. For example, there are as many as 13 different CPT codes for the influenza vaccine, each specific to the type of vaccine and its administration.

The CPT Editorial Panel is responsible for maintaining the CPT code set.

Q: What are the differences between CPT and HCPCS codes?

A: CPT codes refer to medical procedures, while HCPCS codes refer to supplies. Cochlear implant systems have an HCPCS code of L8614 and a CPT procedure code 69930. Baha® implant systems have an HCPCS code of L8690 and a CPT procedure range of 69714-69718.

Q: Should we use ICD-9 or ICD-10?

A: Currently, continue to use ICD-9 until Health and Human Service implant, switch which is scheduled Oct. 1, 2013.

Q: Why are we switching from ICD-9 to ICD-10?

A: Most other countries already use ICD-10. ICD-10 will provide more specific diagnosis and inpatient procedure code information to payers.

Q: Can L codes be billed without a Durable Medical Equipment License?

A: Yes, CI and Baha code L8614 & L8690 are unique codes (HPCS codes). Although most L codes are classified as orthotic or prosthetic, these codes are considered implantable medical devices and are payable in a surgical setting (i.e., ASC, hospital setting).

Q: What are V codes?

A: V codes are a section of the HCPCS code set for vision and hearing codes. A few payers require V codes to report certain Baha services, but in most cases providers should report the specific HCPCS L codes instead.

Q: What is a “DRG code”?

A: A DRG is not actually a type of code, but rather a payment mechanism. It stands for Diagnosis Related Group, and refers to the grouping of services Medicare and some other payers use to reimburse inpatient services. DRGs are assigned based on the combination of ICD-9 procedure codes, diagnosis codes, and other patient factors reported on the claim.

Q: What are modifiers and how are they applicable to implantable hearing solutions?

A: Modifiers are used in conjunction with CPT codes to allow billing of multiple services provided on the same date. For instance, the RT/LT modifier are used to identify services on both the left and right ear. Surgeons and audiologists should check with their Medicare MAC or carrier to determine what modifiers Medicare covers. Additionally, each payer (commercial and Medicaid) may or may not cover certain modifiers under different situations. Since audiologists and surgeons perform bilateral and multiple procedures/services, it is important to check with all payers prior to the use of modifiers. The use of modifiers is an important element in reporting correct coding nomenclature.