Healthcare Common Procedure Coding System (HCPCS) are a set of standardized codes used to identify medical procedures, services and supplies. Proper use of HCPCS codes not only ensures accurate reimbursement but also helps prevent fraud and abuse, particularly in injury-recovery equipment and services.
Evaluating HCPCS Codes
Assessing the appropriateness of HCPCS codes is an important element for adjusters managing claim costs and quality. This process helps ensure medical services and products billed are reasonable, necessary and directly related to a work injury. Here are some key reasons to review HCPCS codes:
Ensuring accurate billing
Determining medical necessity
Identifying inappropriate or excessive charges
Applying fee schedules
Facilitating effective communication with providers
The Importance of Pricing Transparency
Understanding the math behind the cost of durable medical equipment (DME) can often feel like deciphering a foreign language. We've set our reimbursement rates at the appropriate HCPCS level to ensure that each use of the Apricus Specialty Solutions program is cost-effective. This transparency allows you to understand exactly what you're paying for, removing any guesswork from the equation.
Proper HCPCS Coding and State Fee Schedules
One of the most significant benefits of using proper HCPCS coding is its alignment with state fee schedules. This ensures that billing is accurate and compliant with state regulations. Generic codes such as E1399 (Durable medical equipment, miscellaneous), A9999 (Miscellaneous DME supply or accessory, not otherwise specified) and A9900 (Miscellaneous DME supply, accessory, or service component of another HCPCS code) are used for DME supplies or accessories when a specific code is not available for a particular product or service.
Our use of generic HCPCS codes is restricted to less than 5%, ensuring that the services and products are correctly categorized and billed. By adhering to proper coding practices, we not only simplify the billing process but also achieve an average savings of approximately 23%. This is crucial for both cost containment and efficiency in managing claims.
Combatting Fraud and Optimizing Utilization Through Data Analytics
By using proper HCPCS billing codes and reducing generic coding, we enhance billing transparency and improve our ability to quickly identify and resolve issues. This ensures that services are necessary and accurately billed, effectively addressing fraud and abuse. Additionally, our analytics help identify DME utilization trends and ensure appropriate HCPCS code usage. We also help manage direct billing from network providers and monitor out-of-network usage. This data-driven approach provides a clear view of service utilization, enabling better decision-making and resource allocation.
Top 30 Specialty Solutions Items
Here is a list of the top 30 specialty items that are typically billed using HCPCS codes:
K0108: Wheelchair component or accessory, not otherwise specified
L3670: Code for Shoulder orthosis (SO), acromio/clavicular (canvas and webbing type), prefabricated, off-the-shelf
K0001: Standard wheelchair
L3908: Wrist hand orthosis (WHO), wrist extension control cock-up, non molded, prefabricated, off-the-shelf
L4361: Walking boot, pneumatic and/or vacuum, with or without joints, with or without interface material, prefabricated, off-the-shelf
L2999: Lower extremity orthoses, not otherwise specified
L2820: Addition to lower extremity orthosis, soft interface for molded plastic, below knee section
L2397: Addition to lower extremity orthosis, suspension sleeve
L1902: Ankle orthosis, ankle gauntlet or similar, with or without joints, prefabricated, off-the-shelf
L1833: Knee orthosis (KO), adjustable knee joints (unicentric or polycentric), positional orthosis, rigid support, prefabricated, off-the shelf
L3960: Shoulder elbow wrist hand orthosis (SEWHO), abduction positioning, airplane design, prefabricated, includes fitting and adjustment
E0748: Osteogenesis stimulator, electrical, non-invasive, spinal applications
L2275: Addition to lower extremity, varus/valgus correction, plastic modification, padded/lined
L3000: Foot, insert, removable, molded to patient model, 'UCB' type, Berkeley Shell, each
E0265: Hospital bed, total electric (head, foot and height adjustments), with any type side rails, with mattress
E1028: Wheelchair accessory, manual swing away, retractable or removable mounting hardware for joystick, other control interface or positioning accessory
E0747: Osteogenesis stimulator, electrical, non-invasive, other than spinal applications
E0971: Manual wheelchair accessory, anti-tipping device, each
L1820: Knee orthosis (KO), elastic with condylar pads and joints, with or without patellar control, prefabricated, includes fitting and adjustment
E2601: General use wheelchair seat cushion, width less than 22 inches, any depth
L3809: Wrist hand finger orthosis (WHFO), without joint(s), prefabricated, off-the-shelf, any type
E0760: Osteogenesis stimulator, low intensity ultrasound, non-invasive
L0650: Lumbar-sacral orthosis (LSO), sagittal-coronal control, with rigid anterior and posterior frame/panel(s), posterior extends from sacrococcygeal junction to T-9 vertebra, lateral strength provided by rigid lateral frame/panel(s), produces intracavitary pressure to reduce load on intervertebral discs, includes straps, closures, may include padding, shoulder straps, pendulous abdomen design, prefabricated, off-the-shelf
K0195: Elevating leg rests, pair (for use with capped rental wheelchair base)
L1850: Knee orthosis (KO), swedish type, prefabricated, off-the-shelf
E0973: Wheelchair accessory, adjustable height, detachable armrest, complete assembly, each
L3660: Shoulder orthosis (SO), figure of eight design abduction restrainer, canvas and webbing, prefabricated, off-the-shelf
K0003: Lightweight wheelchair
L7499: Upper extremity prosthesis, not otherwise specified
E0990: Wheelchair accessory, elevating leg rest, complete assembly, each
By minimizing the reliance on generic codes and harnessing detailed analytics, Apricus Specialty Solutions empowers you to identify utilization trends, detect fraud and ensure compliance with state fee schedules.