Student Medical Billing and Coding

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HCPCS Level II codes — are grouped according to type of service or supply within a section of the book. They are alphanumeric consisting of a single letter A-V followed by four digits versus CPT® codes that are identified using five digits. Understanding which letter precedes specific types of services, supplies, equipment/devices, and medications is helpful for accurate coding. In the HCPCS Level II code book, instructions and information that are applicable to a specific category of codes are found at the beginning of each major category.

CMS has a decision tree to help the coder determine if the claim needs a HCPCS Level II code. See https://www.cms.gov/medicare/coding-billing/healthcare-common-procedure-system/level-ii-coding-process

HCPCS Level Il codes are divided as follows:

A Codes — Transportation services, medical and surgical supplies, and administrative, miscellaneous and investigational

B Codes — Enteral and parenteral therapy

C Codes — Temporary codes for use with Outpatient Prospective Payment
System (OPPS) (pass-through)

E Codes — Durable medical equipment
(DME)

G Codes — Procedures/professional services

H Codes — Temporary national codes for governmental entities other than Medicare

J Codes — Drugs administered other than oral method and chemotherapy drugs

K Codes — Assigned to DME MAC (temporary)

L Codes — Orthotic procedures and devices and prosthetic procedures

M Codes — Medical services

P Codes — Pathology and laboratory services

Q Codes — Procedures, services, and supplies on a temporary basis

R Codes — Diagnostic radiology services

S Codes — Temporary national codes (non-
Medicare)

T Codes — National codes established for state Medicaid agencies

U Codes — Coronavirus Diagnostic Panel

V Codes — Vision services and hearing, which also includes speech-language pathology services

The beginning of each section contains information and instructions for proper use of codes applying to the specific section. Greater detail will be provided for each of these categories later in this chapter.

CMS publishes Internet Only Manuals (IMs) and a Medicare Learning Network that can help medical billers with billing and coverage instructions on their website. Online documents are not updated with every new Transmittal, Program Memorandum, or Medlearn Matters article, so pay particular attention to when these documents were last updated. Each Medicaid agency maintains its website and program requirements.
Internet-Only Manuals (IOMs): https://www.cms.gov/medicare/regulations-guidance/manuals/internet-only=manuals-ioms

CMS.gov

Designates vaccine codes pending approval from the Food and Drug Administration (FDA). Some vaccine products are assigned a CPT®
Category I code in anticipation of future approval from the FDA. When the vaccine has been approved by the FDA, a revision notation will be provided on the AMA CPT® "Category I Vaccine Codes" website: https://www.ama-assn.org/practice-manageme nt/cpt/category-i-vaccine-codes (see
Appendix K for Products Pending
FDA Approval).

American Medical Association | AMA The American Medical Association, founded in 1847, represents more than 190 state societies and medical specialty associations, including internal medicine, family physician, OBGYN, pediatric and emergency medicine. The AMA is the largest association of physicians – both MDs and DOs – and medica...

billing is the process of submitting and following up on claims with health insurance companies in order to receive payment for services provided by healthcare providers to patients. It involves translating medical procedures, diagnoses, and treatments into codes that are used for billing and reimbursement.

Medical billers are responsible for communicating with insurance companies to verify coverage, submit claims, process payments, and resolve any billing issues or discrepancies that may arise. They must have a good understanding of medical coding systems, insurance regulations, and healthcare billing practices in order to accurately bill and collect payments.

Overall, medical billing plays a crucial role in the healthcare industry by ensuring that healthcare providers receive proper reimbursement for the services they provide, while also helping patients understand their insurance coverage and costs.

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