The Anatomy of Coding

It is imperative to have continuous communication on coding. All information should be both precise and timely in light of annual CPT coding changes. It is important to remain abreast of these changes to ensure accurate coding and appropriate reimbursement. The following symbols can help you track important changes and other information:

•   Indicates a new code and will be placed before the code number.
•   Indicates a code revision that has substantially altered the description of the code.
•   Indicates an add-on code (these can only be used with primary codes and should never be reported alone).
•   Indicates new and revised text other than the procedure descriptor.

HCPCS

HCPCS codes are used to recognize products supplies and services not found in the CPT manual. There are two HCPCS code sets, Levels I and II. Level I codes are based on to CPT codes and are also developed by the AMA. Level II codes are used by medical suppliers such as ambulance services and durable medical equipment vendors. These codes are used to recognize products, supplies, and services not found in the CPT manual (i.e., ambulance services, prosthetics, surgical supplies, and durable medical equipment). There is an alphabetical and a tabular section. Drugs are listed in the alphabetical section by generic and brand name.

Rheumatology practices are typically interested in the product or the drug category of the HCPCS manual. The drug code will usually begin with the letter J, which is followed by five numeric digits. They are commonly called J codes. Temporary drugs consist of a Q followed by five numeric digits. They normally will be assigned a permanent code on January 1 of the following year. Not only will the code give a description of the item billed, it will also distinguish whether equipment is rented or owned, the dosage of a drug, and the mileage in the case of ambulance services. Each code description will support the medical necessity of services given to a patient. For example, in January 2010, the drug codes for Synvics were changed:

• 2009: J7322—Hyaluronan or derivative, Synvisc, for intra-articular injection, per dose
• 2010: J7325—Hyaluronan or derivative, Synvisc or Synvisc-One, for intra-articular

Regardless of the level or intensity of service provided by the physician, one of the critical elements in justifying any diagnosis or procedure during a patient encounter is documentation of the service provided. The physician’s record must accurately document the components of all the services provided. Documentation is critical and should be legible.