Category Archives: Medical Billing

List of HCPCS Categories

The letters at the beginning of HCPCS Level II codes have the following meanings:

  • A-codes (example: A0021): Transportation, Medical & Surgical Supplies, Miscellaneous & Experimental
  • B-codes (example: B4034): Enteral and Parenteral Therapy
  • C-codes (example: C1300): Temporary Hospital Outpatient Prospective Payment System
  • D-codes: Dental Procedures
  • E-codes (example: E0100): Durable Medical Equipment
  • G-codes (example: G0008): Temporary Procedures & Professional Services
  • H-codes (example: H0001): Rehabilitative Services
  • J-codes (example: J0120): Drugs Administered Other Than Oral Method, Chemotherapy Drugs
  • K-codes (example: K0001): Temporary Codes for Durable Medical Equipment Regional Carriers
  • L-codes (example: L0112): Orthotic/Prosthetic Procedures
  • M-codes (example: M0064): Medical Services
  • P-codes (example: P2028): Pathology and Laboratory
  • Q-codes (example: Q0035): Temporary Codes
  • R-codes (example: R0070): Diagnostic Radiology Services
  • S-codes (example: S0012): Private Payer Codes
  • T-codes (example: T1000): State Medicaid Agency Codes
  • V-codes (example: V2020): Vision/Hearing Services

Billing Q&A: What are HCPCS?

HCPCS stands for Healthcare Common Procedure Coding System (HCPCS). For Medicare and other health insurance programs to ensure health care claims are processed in an orderly and consistent manner, standardized coding systems are essential. The HCPCS Level II code set is one of the standard code sets used by medical coders and billers for thisContinue Reading

Billing Q&A: Covering for a Colleague

In part of our Question & Answer Series, today we address a common question about how to do billing when you are covering for another physician. Q:  If I am covering for another physician and see some of his/her patients during his/her absence, are these patients considered new or established? A:  The CPT guidelines specifically addressContinue Reading

How do you get physicians to buy into ICD-10?

Each phase is the prerequisite for the next. Acquiring physician “buy‐in” must be accomplished in order to proceed to the planning and implementation phases. Because many physicians don’t know what they need to know about ICD‐10 in order to implement, analyze, and make informed choices, most practices are currently in Phase One: Engaging and educatingContinue Reading

ICD‐9 AND ICD‐10 Diagnosis Code Format and Differences

ICD‐9‐CM diagnosis codes vs ICD‐10‐CM diagnosis codes 3‐5 characters in length vs 3‐7 characters in length Approximately 14,000 codes vs Approximately 69,000 available codes First digit may be alpha (E or V) or numeric & Digits 2‐5 are numeric vs Digit one is alpha & Digits two and three are numeric & Digits 4‐7 areContinue Reading

Why do we need ICD-10?

ICD‐9‐CM is outdated, over 30 years old, and cannot adequately accommodate the dramatic advances in medicine and medical terminology. Many categories are full and not descriptive enough. Originally utilized for indexing purposes in the hospital inpatient setting, it was never intended to be part of the reimbursement process. An effective coding system needs to be:Continue Reading

The ICD-10-CM Foundation and Background

Definition of Terms In order to be able to discuss the transition from ICD‐9‐CM to ICD10‐CM, you first need to understand the “language” in which the new coding process communicates. Following are terms you need to know. Important Terms for ICD-10 Covered Entity: Providers, payers and clearinghouses who conduct specific administrative transactions electronically. EDI: ElectronicContinue Reading

Verifying Texas Medicaid Eligibility

Each person approved for Medicaid benefits gets a Your Texas Benefits Medicaid card. However, having a card does not necessarily mean the patient has current Medicaid coverage. You must still verify eligibility. There are several ways to do this: • Swipe the patient’s Your Texas Benefits Medicaid card through a standard magnetic card reader, ifContinue Reading

How To Write an Effective Appeal Letter

The following is a list of steps to preparing an appeal: Address the appeal letter to the Insurance Company who paid/rejected the claim. If this is your 2nd Level Appeal or 3rd Level Appeal, notate that on the header also.  If it is your first there is no need to be specific. Put the DateContinue Reading

ICD-10 is delayed another year…

Department of Health and Human Services (HHS) Secretary Kathleen Sebelius announced Monday, April 9th, a proposed rule that would establish a unique health plan identifier under the Health Insurance Portability and Accountability Act of 1996 (HIPAA). The proposed rule would implement several administrative simplification provisions of the Affordable Care Act. The proposed changes would saveContinue Reading