AHA Coding Clinic® for HCPCS - 2008 Quarter 1
Recommendations for submitting HCPCS coding requests
The Central Office on HCPCS receives numerous coding requests on a daily basis. Recently, we have been receiving more requests that either are submitted incorrectly or are issues that the Central Office on HCPCS cannot address. This article was created to provide clarification to our readers on how to properly submit coding requests so that we can prevent delays in responding to the coding requests that we receive. Our primary function at the Central Office on HCPCS is to provide HCPCS Level II coding advice to hospitals, physicians and other health care professionals who bill for Medicare and to...
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Article Overview
This article provides practical guidance for readers who need to route coding questions to the correct organization and submit complete requests. It focuses on the scope of the Central Office on HCPCS, the general categories of HCPCS Level II and CPT inquiries it addresses, and the administrative handling of documentation, duplicate requests, clarification requests, and payment or coverage questions.
Why This Topic Matters
Submitting requests to the right place and with the right supporting information can reduce delays, prevent returned inquiries, and help coding questions reach the office that can actually address them. The article is relevant to hospitals, physicians, and other health care professionals who work with Medicare-related coding support.
Article Sections
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Central Office on HCPCS scope and request routing
Describes the office’s general role and the kinds of coding questions it handles or does not handle. It also addresses where certain inquiries should be directed instead.
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Submitting a coding request
Covers the basic expectations for sending a request, including the need for a specific question and supporting records when appropriate. It also discusses documentation handling and why incomplete submissions may be delayed or returned.
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Coverage and payment requests
Explains how reimbursement, coverage, and payment inquiries are treated and why they are outside the office’s limited coding-advice role. It also notes the general course of action for issues tied to payor decisions.
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Duplicate requests
Addresses how prior requests and status inquiries should be handled to avoid duplicate submissions. It describes the administrative issues that can arise when the same request is sent again without clarification.
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Clarification of previous advice
Explains how to seek follow-up clarification after a response has already been received. It emphasizes referencing the prior correspondence and including relevant supporting materials.
What You Will Learn
- How the Central Office on HCPCS defines its request-handling scope
- Which general HCPCS Level II and CPT request categories are covered
- What information should accompany a coding request
- How duplicate and status inquiries are handled
- How to seek clarification after receiving a prior response
Who Should Read This
- Hospitals
- Physicians
- Other health care professionals who bill Medicare
- Coding staff
- Revenue cycle staff
Code Ranges Discussed
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