Shands Jacksonville Medical Center

Tool Kit for Coding OR Supplies

February 18, 2010

Communicate the following tools used to assign billing codes for supplies:

Internal Guidelines External Guidelines HCPCS codes Definitions Revenue Codes Other HCPCS codes CDM Electronic Request Form Final Result Practice Coding w/ Live Requests

Questions and Answers

Objective

A CDM addition request for a supply must contain the following information:

the PMM # and description using a maximum of thirty-two characters including spaces

the cost per unit paid for the item

the appropriate Revenue Code

the HCPCS code relative to the device

Source: Shands Jacksonville PFS Charge Policy issued 11/3/09

Internal Guidelines

Effective January 1, 2005, hospitals paid under the OPPS (bill types 12X and 13X) that report procedure codes that require the use of devices must also report the applicable HCPCS codes and charges for all devices that are used to perform the procedures where such codes exist and are designated with a status indicator of “N” (for packaged payment) or “H” (for pass-through device payment) in the OPPS Addendum B that applies to the date of service.

Example of HCPCS and status indicators:

HCPCS Code Short Descriptor SI ◦ C1874 Stent, coated/cov w/del sys N◦ C1875 Stent, coated/cov w/o del sy N◦ C1876 Stent, non-coa/non-cov w/del N◦ C1877 Stent, non-coat/cov w/o del N

Sources: Medicare Claims Processing Manual, CR 6416, March 13, 2009 Addendum B, January 2010

External Guidelines

What is a HCPCS code?◦ Healthcare Common Procedure Coding System◦ Developed by Medicare to further standardize coding.◦ Alphabetical letter followed by 4 numerical digits◦ Organized by code number, rather than by service or supply.

Examples of prefixes & definitions: C-drugs, biologicals and device codes

Note: Medicare requires device codes for certain outpt procedures L-prosthetics/orthotics Q-temporary codes for skin substitutes

Exercise #1: Find the HCPCS code for a Guidewire.

HCPCS Codes

What are C-codes?

◦ C-codes are HCPCs codes which may include device categories, new technology procedures and drugs, biologicals and radiopharmaceuticals which do not have other HCPCs codes assigned.

Resources:

◦ CMS Transmittal 11/08 (descriptors of each C code & terms)

◦ CodeCorrect.com (status indicators & reimbursement data)

◦ Vendor websites (billing & coding information)Thumb Drives

Definitions

   

Supply Revenue Codes

Revenue Code Description

270 General Medical Surgical Supplies/Devices

271 Non-Sterile Supply

272 Sterile Supply Items (Surgical Dressings, Staples)

274 HCPCs code required Prosthetic/Orthotic Supplies

275 Pacemaker

276 Intraocular Lens (IOL)

278 Other Implants (Breast Implants)

279 Other Supplies/Devices

Procedure-to-Device Edits

Certain procedures require device codes to be billed in conjunction with the procedure. A claim will be returned if the device code is not on the claim.

Examples:

Source: CY 2010 Procedure-to-Device edits updated 01/06/10

CPT/ HCPCS Description

CY 2010 APC Device A Device A Description

24361 Reconstruct elbow joint 0425 C1776 Joint device (implantable)

24363 Replace elbow joint 0425 C1776 Joint device (implantable)

25441 Reconstruct wrist joint 0425 C1776 Joint device (implantable)

25442 Reconstruct wrist joint 0425 C1776 Joint device (implantable)

25446 Wrist replacement 0425 C1776 Joint device (implantable)

What are L codes?◦ Orthotic and prosthetic procedures and devices◦ Orthotic shoes◦ Prosthetic implants◦ Required for revenue code 274 on outpatient claims

Exercise # 2: Find the HCPCS code for an air cast.

Source: Medicare Claims Processing Manual, Pub. 100-04, chap. 1, sec. 80.3.2.2)

Other HCPCS codes

All requests for Chargemaster maintenance should be submitted via the CDM Electronic Request form, available on Infonet:

**On-line tutorial available 3/1/2010

CDM Electronic Request Form

http://intrashands1.umc.ufl.edu/chargemaster.aspx

Itemized Statement

UB-04 Claim Form

Remittance Advice

Final Result

Practice with Live CDM Requests

Q&A

Wrap Up