2. Communicate the following tools used to assign billing codes for
supplies:
Internal Guidelines
External Guidelines
HCPCS codes
Definitions
Revenue Codes
Other HCPCS codes
CDM Electronic Request Form
Final Result
Practice Coding w/ Live Requests
Questions and Answers
3. A CDM addition request for a supply must contain the following
information:
the PMM # and description using a maximum of thirty-two characters
including spaces
the cost per unit paid for the item
the appropriate Revenue Code
the HCPCS code relative to the device
Source: Shands Jacksonville PFS Charge Policy issued 11/3/09
4. Effective January 1, 2005, hospitals paid under the OPPS (bill types 12X
and 13X) that report procedure codes that require the use of devices must
also report the applicable HCPCS codes and charges for all devices that
are used to perform the procedures where such codes exist and are
designated with a status indicator of “N” (for packaged payment) or “H” (for
pass-through device payment) in the OPPS Addendum B that applies to the
date of service.
Example of HCPCS and status indicators:
HCPCS Code Short Descriptor SI
◦ C1874 Stent, coated/cov w/del sys N
◦ C1875 Stent, coated/cov w/o del sy N
◦ C1876 Stent, non-coa/non-cov w/del N
◦ C1877 Stent, non-coat/cov w/o del N
Sources: Medicare Claims Processing Manual, CR 6416, March 13, 2009
Addendum B, January 2010
5. What is a HCPCS code?
◦ Healthcare Common Procedure Coding System
◦ Developed by Medicare to further standardize coding.
◦ Alphabetical letter followed by 4 numerical digits
◦ Organized by code number, rather than by service or supply.
Examples of prefixes & definitions:
C-drugs, biologicals and device codes
Note: Medicare requires device codes for certain outpt procedures
L-prosthetics/orthotics
Q-temporary codes for skin substitutes
Exercise #1: Find the HCPCS code for a Guidewire.
6. What are C-codes?
◦ C-codes are HCPCs codes which may include device categories,
new technology procedures and drugs, biologicals and
radiopharmaceuticals which do not have other HCPCs codes
assigned.
Resources:
◦ CMS Transmittal 11/08 (descriptors of each C code & terms)
◦ CodeCorrect.com (status indicators & reimbursement data)
◦ Vendor websites (billing & coding information)
Thumb Drives
7. Revenue Code Description
270 General Medical Surgical Supplies/Devices
271 Non-Sterile Supply
272 Sterile Supply Items (Surgical Dressings, Staples)
274 HCPCs code required Prosthetic/Orthotic Supplies
275 Pacemaker
276 Intraocular Lens (IOL)
278 Other Implants (Breast Implants)
279 Other Supplies/Devices
9. What are L codes?
◦ Orthotic and prosthetic procedures and devices
◦ Orthotic shoes
◦ Prosthetic implants
◦ Required for revenue code 274 on outpatient claims
Exercise # 2: Find the HCPCS code for an air cast.
Source: Medicare Claims Processing Manual, Pub. 100-04, chap. 1, sec. 80.3.2.2)
10. All requests for Chargemaster maintenance should be submitted via
the CDM Electronic Request form, available on Infonet:
**On-line tutorial available 3/1/2010
http://intrashands1.umc.ufl.edu/chargemaster.aspx
