Also pronounced hick-picks, Healthcare Common Procedure Coding System (HCPCS) came into being to provide a standardized coding system. Although these codes were used voluntarily initially, nowadays most organizations include HCPCS codes for electronic transactions.

HCPCS codes are two tiered, referred to as Level I and level II.

HCPCS CPT code: The first level is the CPT coding system, which was developed by American Medical Association (AMA). Level I comprises Current Procedural Terminology (CPT-4) codes and are used for any in-patient or office visits where the treatment or supplies is used in the medical facility.

On the other hand, the second tier is the HCPCS Level II coding which was developed by Centers for Medicare and Medicaid Services (CMS). These codes are also referred to as alpha-numeric codes because they consist of a single alphabetical letter followed by 4 numeric digits. These codes are used for billing ambulance services, prosthetics and other insurance to cover items outside of an office visit.

A brief history of HCPCS coding:

The first level of HCPCS codes came into being way before the 1980s. As new procedures and systems came into being, the second level was created during the early 1980s. The third level of HCPCS codes came into existence in 2003 as new procedures and medical tools were available to localized markets. These codes were developed by both public and private payers on a local level. However, Level III codes are no longer in use these days.

HCPCS code sets and manuals are updated at the start of every calendar year. The changes include coding additions, deletions and replacements.

One of the most significant changes for Medicare billing recently is the elimination of payment for consultation codes. Your practice will have to adjust how you bill for these types of services or you will find a lot of denials.

Just in case you have not had a chance to read the newly released fee schedule (just kidding, it is a lot to read), I have summarized the section on consulting codes below.

Here are the facts regarding this new ruling and the potential impact on your practice.

1. Consultation codes 99241-99245 (outpatient/office) and 99251-99255 (inpatient) have been eliminated. Tele-health consultation G-codes (G0425-G0427) will not be eliminated.

2. Use codes for new (99201-99205) or established (99211-99215) patients to replace consultations in the office/outpatient setting.

3. Codes in the inpatient hospital setting (99221-99223) should be used to replace inpatient consultation codes (99251-99255), and for nursing facility consultations use codes (99304-99306).

4. To distinguish the difference between the admitting physician of record from the consultants for initial hospital inpatient and nursing facility admissions, Medicare will develop a modifier. Check with your local carrier for more information.

5. Payments for all Evaluation and Management codes have been increased in an attempt to offset the fees lost from the elimination of consultation codes.

An important note regarding commercial or private insurance. No information has been released by other third party payers regarding payment for consultation codes as of yet. However, if your patient has Medicare as a secondary payer, a decision will need to be made by the physician as to how you will report the consultation. Any consultation claim filed with a commercial insurer such as Blue Cross or Aetna who is primary using the eliminated consultation codes when Medicare is secondary would result in a denial for the secondary claim by Medicare. In those instances where Medicare is secondary, you may want to consider using the new guidelines as stated above for reporting consultation codes.

One more note. If you have not updated your enrollment information with Medicare since November 2003, you must do so. Although enrolled in Medicare, many physicians who are eligible to refer Medicare beneficiaries to other Medicare providers or suppliers for services do not have current enrollment records in Medicare. A current enrollment record is one that is in the Medicare provider enrollment, chain and ownership system (PECOS) and also contains the physician’s national provider identifier (NPI).

Follow these few simple guidelines and you should have no problem being paid for consulting codes.

Workers’ compensation insurance in Florida and roughly 40 other states, use a classification code system designed by the National Council on Compensation Insurance (NCCI) to rate insurance premiums differently for groups of employees. There are roughly 600 class codes, and the two main codes used for employees in the landscaping industry are 0042 and 9102.

I often encounter landscape maintenance businesses that have their employees misclassified and are able to not only receive a 50% reduction on their current insurance premiums, but are also able to file for reimbursements from overpayments on previous workers compensation policies.

These experiences and multiple other questions about how these classification codes may be used together on a policy, have brought to my attention a need to communicate specific information to the landscaping industry about the uses of workers compensation codes 0042 and 9102.

First, let’s start with a brief description of each classification code with quotes from NCCI’s official descriptions:

Class Code 0042 – Applies to employees primarily engaged in planning, clearing, grading, laying of sod, seeding, and planting necessary for landscape installation operations. Planting of trees, shrubs, and flowers are classified to this code along with general gardening activities.

Class Code 9102 – Applies to employees that perform maintenance of lawns, grounds, and gardens. “The maintenance may involve lawn mowing, raking, application of liquid or granular fertilizer, spraying and trimming of shrubs or small trees from the ground, and thatching or aerating. If any one or all of the above operations are performed by a lawn maintenance risk classified to Code 9102, then minor and incidental landscaping operations performed by the same risk, such as the replacement of dead shrubs, the planting of a few flowers, and the placing of rock or brick as edging designs are included under Code 9102. This minor landscaping operation is distinguished from work performed by an insured at a job or location where the primary work at the job or location is landscaping. Since lawn spraying is a maintenance operation, a risk engaged exclusively in work of this nature is classified to Code 9102.”

In Florida, the 2010 rates for theses class codes are 6.36 for code 0042 and 3.49 for code 9102. In the other states, class code 0042 also has a significantly higher rating than class code 9102. For businesses in the landscaping industry, this emphasizes the importance of distinguishing between the two classification codes.

In many states, employees that engage in both landscape installation and landscape maintenance activities can have their corresponding payroll divided between the class codes if proper records are maintained. Consult with your insurance agent for the specific classification rules in your local state. According to the state exception wording under the 9102 class code, Florida landscaping businesses can use class code 0042 and 9102 on their workers’ compensation policy only if those “operations described by these classifications are conducted by separate crews.”

ICD – 10 Guidelines Chapter-1 Selection and Sequencing of MRSA

Methicillin Resistant Staphylococcus aureus Conditions

1) Selection and sequencing of

(a) Combination for infection

When a patient is diagnosed with infection like sepsis due to MRSA give combination

Sepsis due to Methicillin resistant aureus code A41.02

Pneumonia due to Methicillin resistant Staphylococcus aureus c J15.212

B95.62, Methicillin resistant aureus infection as the cause of diseases classified elsewhere, as an additional code,

Because the combination code includes the type of infection and the MRSA organism

Don’t code z 16.11 resistance to pencillins

(b) Other for infection

When a patient is diagnosed with infection like (e.g., wound infection, stitch abscess, urinary tract infection) due to MRSA and this if we don’t have combo code

so in this cases B95.62, Methicillin resistant Staphylococcus aureus infection as the cause of diseases classified elsewhere for the MRSA infection.

Don’t code z 16.11 resistance to pencillins

UTI due to MRSA how to code?

PDX:n39.0

SDX:B95.62

(c) Methicillin susceptible aureus () and colonization

Colonization or carrying: when MSSA or organism is present in the body without causing illness is known as colonization or carrier of MSSA.

When the positive colonization documentation is given by provider such as” screen positive” or “nasal swab positive”.

code Z22.322, Carrier or suspected carrier of Methicillin resistant Staphylococcus aureus, for patients documented as having MRSA colonization.

code Z22.321, Carrier or suspected carrier of Methicillin susceptible aureus, for patient documented as having MSSA colonization.

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(d) MRSA colonization and infection

When patient is having both MRSA colonization and infection developed during admission both infection and MRSA colonization.

Ex: sepsis and MRSA colonization.

PDX: A41.9

SDX: Z22.322

(f) Zika virus infections.

1) only confirmed cases

When provider documentation is given as conformed zika virus then A92.5.

Don’t code if documentation is given as probable, suspected or possible assign the reason for visit complaint like fever, joint pain etc., or

Z20.828, Contact with and (suspected) exposure to other viral communicable diseases.

4) Sepsis and severe sepsis with a localized infection

If patient admitted with sepsis and severe sepsis and a local infection such as pneumonia and cellulitis

First code systemic infection is coded

Second localized infection is coded

Third severe sepsis is coded.

If patient admitted for local infection and there is no severe sepsis until admission and developed later then

First local infection is coded

Second sepsis, severe sepsis.

Developed by the American Medical Association (AMA), CPT coding is a standard code that is applied to procedures and services for the purpose of patient records. There are three types of CPT codes: Category I, II and III.

Category III types codes are temporary codes for new and emerging technologies. The idea behind this category of codes is to aid researchers track emerging technology and services to substantiate extensive usage and clinical efficiency. So if you are someone who embraces new technology, there’s quite a possibility that you are familiar with Category type III CPT codes.

This category of CPT codes has been created to allow for data collection and utilization tracking for new procedures that do not meet the criteria for Category I CPT codes. Category III codes comprise five digits, with four digits followed by the letter ‘T’ in the last field. These codes are temporary in nature and will make an exit if the procedure or service does not get accepted as Category I code within five years.

Few things to keep in mind about this type of Category codes:

* As per AMA, it’s not right to use a CPT I code or an unlisted procedure if Category III code exists

* Identify a base code that’s quite like the Category III code

* Determine the fee schedule for the Category III code using the same methodology as for unlisted procedures

* Watch the reimbursements closely

The AMA updates these codes twice a year, in January and July. So if you need to get hold of the most current listing of CPT III codes, you can check out the AMA website.

A new suggestion that is good is a new reality that is ultimately good and beneficial. With that dramatic statement, I begin this article. Why live in the past, progress is a good thing, especially when you know how to work the progress to your genuine benefit and progressively better reality. The past and living in it literally is stagnation in every genuine sense.

In reality, the meaning of evolution is forward, not backward or stagnant, literally.

I remember a friend of mine once said: “I wish I could go back in time to an earlier age that was better.” Well, I had a simple answer to that: “Even if you went back in time and came back up to now, you would still be in this time anyway.”

The point of my answer was not to shut him up or put him down, it was to show him how reality genuinely works, and if the flow is not genuinely gone with, it will leave you behind even if you have the means and ability to genuinely cheat or circumvent. In fact, cheating and circumventing reality is not going with the flow, it is actually deeply breaking the law, even if “undetectable” by the best of others. Indeed, cheating is not superior ability even if “you get away with it”, it is cheating. Why do you think the philosophies of Plato, Marx and Kant sound so good but never work in practice, they are based on socialism, irrationally controlling behaviors, and conniving trickery that looks like law and order. Let us be honest there. For honesty, logic and not cheating will get you everywhere without your conscience biting at you in such destructive ways although it will take “longer” and require more earning power, it is worth it. Indeed, the ancient codes say that philosophy and religion are supposed to hold the answers. I say the answers are genuinely within our honesty and ability to genuinely earn our way through reality, that is where the answers are. Call it a “new code”, call it “how it really works”, but ultimately it has the merit of being an honest, working way to live: Not looking for short cuts and cheating ways to live, if you get where I am coming from so far.

Sometimes, I remember what my Dad used to say with a chuckle: “Nobody can fool their own mind into thinking wrong is right and right is wrong, whatever they do.” Indeed, we can go every other way than right thinking we will win cheating, but even if we do, we know we have cheated, that is conscience, reality and fact calling us to make amends even if “we got away with it.” That really is beyond ancient codes that call to make it easier, is it not? Indeed, earning and the hard way is the only way, and if we really want what we want, we will do it honestly.