Avoid These Top Trouble Spots to Ensure Flawless HCPCS Coding

You can use HCPCS level II codes to report for drugs and supplies, performance measures, and even procedures. The wide range of possibilities leaves a lot of room for error on your claims, so if you report HCPCS codes, you should get to know the sections that apply to what you do. Here are some top sections for physician coders to know and the areas where you should apply extra caution.

C Codes: Think Twice Before Using These Codes

The main thing pro fee coders need to know about C codes is that you probably aren’t going to use them. CMS established C codes for Outpatient Prospective Payment System (OPPS) providers.

There are a few exceptions. Check for special rules if you code for a CAH, IHS, Maryland waiver hospital, or a hospital in American Samoa, Guam, Saipan, or the Virgin Islands.

G and Q Codes: Watch for When Medicare Requires These, Not CPT®

G and Q codes are temporary codes and codes not found elsewhere in HCPCS or CPT®, so they can cover a wide variety of procedures and supplies. That means that the code you need may not be in the HCPCS codes range you expect, but may be in the G or Q code section instead.

An important note here is that G codes and Q codes also include codes that Medicare requires you to use in place of certain CPT® codes. For instance, there is G0008 (Administration of influenza virus vaccine) which you should report to Medicare for flu vaccine administration instead of using a CPT® code. Another example is Q0091 (Screening Papanicolaou smear; obtaining, preparing and conveyance of cervical or vaginal smear to laboratory). Both of these are common services, proving the importance of minding your Gs and Qs.

Tips: If your HCPCS code lookup resource includes space for personal notes, consider adding a reminder by relevant CPT® codes about which HCPCS G code or Q code Medicare requires instead.

J Codes: Bring Your Math Skills to Avoid Unit Errors

To report the supply of drugs and biological agents, you’ll turn to the J codes. One of the biggest problem areas for J codes is reporting units. You must consider both the amount listed in the code descriptor and the amount administered to determine the correct number of units for your HCPCS code.

For example, pay attention to the 10 mg in this descriptor: J9305 (Injection, pemetrexed, 10 mg). That means that for every 10 mg administered, you report 1 unit of J9305. If you mistakenly report 10 units per 10 mg, you’ll be over-reporting significantly.

Reporting too many units may result in having to send money back to the payer in some instances, but, in many cases, you’re likely to run up against a Medically Unlikely Edit (MUE) first. Medicare creates MUEs for many codes to tell you the maximum number of units allowed for a code.

To continue using J9305 as an example, suppose documentation shows ordering and administration of 900 mg pemetrexed. You should report 90 units of J9305 because 900 mg divided by 10 mg results in 90 units. If you accidentally reported 900 units instead, you’d be over the practitioner MUE, which is 150 in the third quarter of 2018. The payer will deny the lines with J9305 when you are over the MUE for a date of service.

Smart move: If your HCPCS lookup resource includes MUEs, check them before you finalize your claim. That will help you catch errors before you submit the HCPCS code on the claim.

Know the Codes and Updates for Your Specialties and Your Payers

C, G, Q, and J codes are not the only ranges you’ll find in your HCPCS code lookup. You may find that your private payer requires you to use codes in the S code HCPCS range. Or HCPCS may have codes specific to your specialty. For instance, if you report vision services and supplies, you may find your coding focused on V2020-V2799.

One final note is that HCPCS changes come out quarterly, effective January 1, April 1, July 1, and October 1. So you need to check each quarter to be sure your HCPCS lookup resource is ready and that you know how to use the updates that apply to you.

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