Why was hcpcs level 2 established

The G codes are used to identify professional healthcare procedures and services that would otherwise be coded in CPT but for which there are no CPT codes. Codes to report demonstration projects are included in this section. Example: G Administration of influenza virus vaccine. Certain H codes are used by those state Medicaid agencies that are mandated by state law to establish separate codes for identifying mental health services such as alcohol and drug treatment services.

The Q codes are used to identify services that would not be given a CPT code or a permanent national code but are needed for claims processing purposes. Prior to the advent of procedure coding, providers submitted written descriptions of the services they performed to payers for reimbursement.

This proved inefficient, in that providers could report the same service with different descriptions. By this time, the government had become a major payer of healthcare services.

While it too needed to standardize healthcare claims, it also bore the responsibility of controlling costs for taxpayers. But standardization in medical reporting was not yet achieved. Figure 1: Development of procedure coding systems. For example, codes beginning with the letter J—used to report non-orally administered medication and chemotherapy drugs—are called J codes.

A HCPCS code is then added to the claim when required by the payer to report products that may have been prescribed, injected, or otherwise delivered to the patient during the service. In general terms—with some exceptions—medical coders use the three code sets when submitting medical claims to report the following:. For example, if a urologist diagnoses a patient with bladder cancer and performs a bladder instillation of 1 mg of Bacillus Calmette-Guerin BCG to treat the tumor, the medical coder might assign:.

The medical coder must verify coverage with the payer prior to submitting a claim. Several third-party payers follow Medicare guidelines, but you must check with your payer. Screening procedures are not diagnostic procedures. Note: G…. Your email address will not be published.

Save my name, email, and website in this browser for the next time I comment. Brief communication technology-based service, e. G Implemented by CMS in calendar year on an interim basis.