The last time information was published in Coding Clinic for HCPCS with recommendations for submitting HCPCS Coding Requests was in 2008. Since that time much has changed. For instance, in 2008, requests were submitted in writing and received via fax or in the mail. We have been automated for several years now, and questions are submitted on-line via CodingClinicAdvisor.com. And while the submission process has changed, the types of questions we can answer has not changed. The services provided by the Central Office for HCPCS has always been to assist with HCPCS Level I and Level II coding questions specific to hospital/facility outpatient reporting. This does NOT include physician-based coding questions, questions pertaining to inpatient procedures, billing and reimbursement, or documentation issues. Direct any coding questions pertaining to physician services including physician services performed in the inpatient setting to the American Medical Association (AMA) for assistance, billing and reimbursement issues are best addressed by the individual payers, as payment policies are not all the same. This article is intended to provide information so that we can respond to your requests efficiently and in as timely a manner as possible.
First, it’s important to note that questions are processed free of charge, however, we can only accept one question per request. When submitting questions, include documents (such as medical record documentation) that provide context to the question being submitted. Do not submit any document that contains Personal Health Information (PHI), physician name(s), or hospital name(s). Any question submission or related document that includes PHI, physician names, or hospital names will not be accepted or answered.
The types of facility/based coding questions we can accept include the following:
- Level I HCPCS (CPT codes) for hospital providers
- Level II HCPCS codes for hospitals, physicians and other health professionals
The types of questions we are unable to respond to include:
- Inquiries from physician providers related to CPT. As stated above, these questions should be referred to the American Medical Association (AMA).
- Questions related to HCPCS Level II codes related to durable medical equipment, prosthetics, orthotics, and other supplies. These questions should be referred to the DME Medicare Administrative Contractors (MACs). These codes do not apply to hospital or physician providers.
- Questions related to payment or coverage issues
- Questions without supporting medical record documentation
- Questions related to missing or incomplete documentation or validation of what is appropriate documentation (paper or electronic)
- Questions related to mediating differences of opinion between providers and auditors or payers or any other third-party reviewers — unless it relates to the application of specific coding guidelines or specific previously published coding advice
- Questions related to HCPCS coding of inpatient procedures
We are aware that more and more procedures are being performed in the outpatient setting. In order to make the distinction between inpatient and outpatient procedures, from the standpoint of what we are able to address, we are guided by the procedures listed on the Medicare Inpatient Only (IPO) list. This list is updated annually and any requests pertaining to procedures that appear on the list for the current year, will not be answered. Changes and discussion to the annual IPO List can be found in the annual Calendar Year (CY) OPPS/ASC final rules.
The Central Office appreciates your coding requests and for the opportunity to assist hospital outpatient coding professionals by providing timely and accurate responses. By submitting specific, formulated questions with corresponding documentation pertaining to outpatient procedures, we hope to continue to provide coding assistance.
Please log on to CodingClinicAdvisor.com for additional information and submission of coding requests.