HCPCS Codes May Spell Respite for Undefined CPT® Services

Even though pediatricians aren't accustomed of using HCPCS codes, the level-two S codes provide potential medical coding and reimbursement for services that CPT does not outline. Once a pediatrician offers a service that CPT does not define, follow the following listed three steps to use HCPCS level-two S codes to resolve the reimbursement hitch.

1. Know Who Admits S Codes

Blue Cross/Blue Shield (BCBS) established the S codes for reporting drugs, supplies and services. You must use these HCPCS codes at that time when no CPT code is present, when the HCPCS code is more precise, or when the third-party payer necessitates it. The codes are entirely for use with private payers. Medicare does not admit them.

In case an S code correctly describes the service provided, make certain the carrier will accept it. You must read material for instance newsletters and carriers' local medical review policies to stay well-informed. It's also significant to evaluate the HCPCS codes in the insurance fee or payment schedule. In case the code is not listed, it's generally not payable.

2. Watch Out for Common Areas of Use

Coders regularly have problems billing for suture removal delivered by a different physician. As far as these services are concerned, you must consider using a HCPCS code.

To bill for suture removal by a physician except the physician who initially closed the wound, you should bill S0630 (Removal of sutures by a physician other than the physician who originally closed the wound) to BCBS of Michigan. To all other carriers, we report a problem-oriented E/M code (99201-99215), and link ICD-9 code V58.3 (Attention to surgical dressings and sutures) with it.

Use the similar diagnosis medical coding for HCPCS codes as you would for the CPT code. There is no dissimilarity.

3. Generate a System of Payer-Appropriate Codes

Using the codes that individual insurers identify can help get claims paid on the first try. On the other hand, keeping track of the numerous codes to use for each carrier can pose a logistical nightmare. To solve this logistical problem, design an encounter form to help your pediatricians and billers keep the codes straight. Group the CPT or HCPCS code by the major insurance companies. Under the category of suture removal by dissimilar physician, the biller chooses from the following:

ALL OTHER INSURANCE

99201-99215 - Sick visit office code (V58.3).

Provided that you did the research described in step 2 and made a chart of your findings (step 3), carriers should not reject your claims. In case you have to appeal, you must send copies of the HCPCS book to prove that the code is not a deleted or an obsolete code.

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