AHA Coding Clinic® for HCPCS - 2005 Issue 3
An important reminder
The Centers for Medicare & Medicaid Services (CMS) will no longer permit the submission of claims with discontinued HCPCS Level I and Level II codes. The Health Insurance Portability and Accountability Act (HIPAA) transaction and code set rule requires usage of the medical code set that is valid at the time service is provided. Therefore, since January 1, 2005 the 90-day grace period for billing discontinued HCPCS codes was eliminated by CMS. Facilities are instructed to stay abreast of all annual and mid-year changes, i.e. new, revised, and discontinued HCPCS codes, with updated code books and by accessing...
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Article Overview
This article summarizes a CMS reminder for facilities and billing staff about using HCPCS code sets that are valid when services are provided. It explains the relevance of annual and mid-year HCPCS updates and points readers to CMS for current code-change listings.
Why This Topic Matters
It helps coders and billing teams avoid using outdated HCPCS codes on claims and stay aligned with CMS and HIPAA code-set requirements.
What You Will Learn
- Why HCPCS code validity matters for claims processing
- How CMS guidance affects monitoring of code updates
- Where to look for current HCPCS changes and discontinued-code information
- Who should pay attention to annual and mid-year HCPCS revisions
Who Should Read This
- Medical coders
- Billing staff
- Revenue cycle professionals
- Facility compliance teams
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