Chapter 9: Introduction to Level II
National Codes (HCPCS) Test-Graded
A
HCPCS - ANSWER-Healthcare Common Procedure Coding System (pronounced hick-
picks)
HCPCS developed when - ANSWER-1983
HCPCS developed by - ANSWER-CMS
HCPCS definition - ANSWER-a collection of codes that represents
• procedures,
• supplies,
• products, and
• services
provided to
• Medicare and
• Medicaid beneficiaries and to
• individuals enrolled in private insurance
HCPCS Levels - ANSWER-I and II. Level III (state codes) no longer in use.
Level I - ANSWER-includes CPT developed, maintained, and copyrighted by the AMA --
is the primary coding system used in outpatient settings to code professional services
provided to patients
Level II - ANSWER-HCPCS codes (National codes) represent physician and non-
physician services, products and supplies that are not represented in the Level I codes.
In some cases, Medicare requires the use of a Level II HCPCS code to override an
already existing CPT code.
Level II code examples - ANSWER-• Ambulance services
• Durable Medical Equipment
• Drugs
• Prosthetics
• Orthotics
Level II format - ANSWER-five character alphanumeric (first character is a letter,
followed by 4 numbers)
, Additional Info Required with Miscellaneous Codes - ANSWER-• Description
• Manufacturer's name
• Brand/generic name, dose, and NDC number (drugs)
• Product name and number
• Price
• Explanation of patient need
Miscellaneous Codes Without Additional Info - ANSWER-Claim will be denied
HCPCS Manual Updates - ANSWER-All codes and descriptions are update annually by
CMS in November for January 1 use. Quarterly updates are provided online.
HCPCS Manual Contents - ANSWER-• General guidelines
• List of modifiers
• HCPCS Codes
• Table of Drugs
• Index
HCPCS Index Details - ANSWER-Alphabetical order, includes main and subterms
Alphanumeric Listing - ANSWER-List of codes with further explanation of what is
included
1st General Rule for Level II Coding - ANSWER-Never code directly from the index --
use both the alphanumeric listing and the index
2nd General Rule for Level II Coding - ANSWER-Analyze the statement or description
provided that designates the item that requires a code.
3rd General Rule for Level II Coding - ANSWER-Identify the main term in the index.
4th General Rule for Level II Coding - ANSWER-Check the relevant sub terms under
the main term. Verify the meaning of any unfamiliar abbreviations.
5th General Rule for Level II Coding - ANSWER-Note the code(s) found after the
selected main term or sub term.
6th General Rule for Level II Coding - ANSWER-After locating the term and the code in
the index, verify the code in the tabular to ensure the specificity of the code.
7th General Rule for Level II Coding - ANSWER-• In most cases, for each entry, a
specific code is provided.
• In some cases, you are referred to a range of codes among which you can locate the
required code.
National Codes (HCPCS) Test-Graded
A
HCPCS - ANSWER-Healthcare Common Procedure Coding System (pronounced hick-
picks)
HCPCS developed when - ANSWER-1983
HCPCS developed by - ANSWER-CMS
HCPCS definition - ANSWER-a collection of codes that represents
• procedures,
• supplies,
• products, and
• services
provided to
• Medicare and
• Medicaid beneficiaries and to
• individuals enrolled in private insurance
HCPCS Levels - ANSWER-I and II. Level III (state codes) no longer in use.
Level I - ANSWER-includes CPT developed, maintained, and copyrighted by the AMA --
is the primary coding system used in outpatient settings to code professional services
provided to patients
Level II - ANSWER-HCPCS codes (National codes) represent physician and non-
physician services, products and supplies that are not represented in the Level I codes.
In some cases, Medicare requires the use of a Level II HCPCS code to override an
already existing CPT code.
Level II code examples - ANSWER-• Ambulance services
• Durable Medical Equipment
• Drugs
• Prosthetics
• Orthotics
Level II format - ANSWER-five character alphanumeric (first character is a letter,
followed by 4 numbers)
, Additional Info Required with Miscellaneous Codes - ANSWER-• Description
• Manufacturer's name
• Brand/generic name, dose, and NDC number (drugs)
• Product name and number
• Price
• Explanation of patient need
Miscellaneous Codes Without Additional Info - ANSWER-Claim will be denied
HCPCS Manual Updates - ANSWER-All codes and descriptions are update annually by
CMS in November for January 1 use. Quarterly updates are provided online.
HCPCS Manual Contents - ANSWER-• General guidelines
• List of modifiers
• HCPCS Codes
• Table of Drugs
• Index
HCPCS Index Details - ANSWER-Alphabetical order, includes main and subterms
Alphanumeric Listing - ANSWER-List of codes with further explanation of what is
included
1st General Rule for Level II Coding - ANSWER-Never code directly from the index --
use both the alphanumeric listing and the index
2nd General Rule for Level II Coding - ANSWER-Analyze the statement or description
provided that designates the item that requires a code.
3rd General Rule for Level II Coding - ANSWER-Identify the main term in the index.
4th General Rule for Level II Coding - ANSWER-Check the relevant sub terms under
the main term. Verify the meaning of any unfamiliar abbreviations.
5th General Rule for Level II Coding - ANSWER-Note the code(s) found after the
selected main term or sub term.
6th General Rule for Level II Coding - ANSWER-After locating the term and the code in
the index, verify the code in the tabular to ensure the specificity of the code.
7th General Rule for Level II Coding - ANSWER-• In most cases, for each entry, a
specific code is provided.
• In some cases, you are referred to a range of codes among which you can locate the
required code.
