Who is responsible for updating hcpcs codes
Commercial health insurance policies may consider some pairs of codes acceptable for reimbursement, while the NCCI does not.
Professional medical billers need to be able to recognize that while all CPT codes are HCPCS codes, not all CPT codes are used the same way when they are HCPCS codes.
The NCCI Coding Policy Manual that is published annually by CMS describes why the NCCI considers how some codes cannot be logically reported on the same healthcare claim.
Most of these mirror the instructions contained in CPT, but because CMS deals with HCPCS codes rather than CPT codes, the rationale is not universal.
The NCCI Coding Policy Manual is divided into chapters that mirror the systematic divisions in CPT by specialty.
Each chapter includes an introduction that addresses specific codes and how CMS defines their use.
Medical billers and medical coders need to be aware of the current guidance established by the NCCI when they submit claims to Medicare.
While CPT codes are used to describe medical services provided to patients, HCPCS codes are used specifically to bill Medicare.
This is because the NCCI arranges codes in one column (Column One) and lists codes unlikely to be reported at the same time in an opposing column (Column Two). In CPT, the AMA does not determine whether services can, or should, be performed together, leaving that up to the discretion of the healthcare provider.
Through the NCCI, CMS determines that some procedures are included in the performance of other procedures performed during the same patient encounter, and that only one code is likely to appropriate for reimbursement purposes.
Understanding the use of HCPCS Level I codes is essential for professional medical billers to obtain maximum, legal reimbursement for their employers.
CMS reviews the guidelines the AMA uses to define CPT codes, then it establishes coding methodologies and policies that promote correct coding on a national scale.