HCPCS HCPCS Level II

[Sparky]

I reviewed the brief YouTube presentation about HCPCS and downloaded the Modifier Grid but still have questions on when do I know if the modifiers are feasible with minimal information.

I have ten to complete but only listed four of those ten which is on my exam (this are the actual lines listed): I have all my codes in place, but not sure if I need to add modifiers, and if applicable?

Transportation of a portable EKG to a physician's office for a patient (R0076)

Colorectal rectal cancer screening flexible sigmoidoscopy. (G0104)

Gastrostomy tubing (B4087 - Standard / B4088 - Low Profile)

Psychiatrist screens a patient to determine eligibility for an alcohol and drug program (H0002)

 

[Carolyn Heath]

I am not sure, but I am thinking that you do not need modifiers for HCPCS codes. I do know that you use modifiers for the CPT codes.

 

[Sparky]

Thanks Carolyn

 

[Carolyn Heath]

You are welcome, Sparky!

 

[Ruth Sheets]

I never thought about using Modifiers with HCPCS Level II codes before, but there are Modifiers listed in Appendix 2 of the HCPCS manual. For example, suppose a patient with 2 broken thumbs required 2 splints, one for each thumb. The splints that were used could be coded Q4049 X 2, Finger splint, static, times 2. It would be better to code Q4049-F5, Q4049-FA. indicating the right and left thumbs, assuming the payer wanted it this way.

I think you have to remember that modifiers are used to "round out the story." In the original question these descriptions don't need any more "rounding out to complete the story", so I agree they wouldn't need Modifiers:

• Transportation of a portable EKG to a physician's office for a patient (R0076)
• Colorectal rectal cancer screening flexible sigmoidoscopy. (G0104)
• Gastrostomy tubing (B4087 - Standard / B4088 - Low Profile)
• Psychiatrist screens a patient to determine eligibility for an alcohol and drug program (H0002)

I don't know for sure, but it seems plausible that there may be occasions where HCPCS modifiers are needed for HCPCS codes.

Could we have an expert weigh in on this?

 

[Laureen]

HCPCS Level II codes i.e.. the alphanumeric codes absolutely take modifiers. If a modifier is needed to tell the full story then yes you use them. You can mix and match HCPCS Level I (CPT) modifiers with HCPCS Level II modifiers. Don't we use RT and LT all the time on CPT codes?

I'm not sure about what the original question is asking. Are you just being given a code and asked what POSSIBLE modifiers you could use? For example G0104 is a procedure that may be started and have to be stopped - you'd need a modifier to tell that story. Do you know what you could use?

 

[Carolyn Heath]

Thanks, Ruth and Laureen, for clearing that up. I am beginning to understand a little about modifiers in HCPCS Level I (CPT) and HCPCS Level II and how to use them.

 

[Sparky]

With the four examples from my exam I not sure on what I could use? With teaching myself on reading online material I am guessing for the R0076 that the Modifier is TC but not confident it is correct. I have nine more examples to deal with and feel I am not going to get it right.

I am still confused about modifiers in both HCPCS Level I and II.

 

[Sparky]

I researched the internet, found the complete listing of all HCPCS Level II modifiers. I will study them and see if I can figure this out. Again, I will NOT quit, I will move forward, teach myself the best to my ability; until I need to ask more questions. I do appreciate everyone's support and knowledge that is shared and trust me I am filling my note pad(s) with all this. Thank you, Thank you to ALL....................YOU ARE THE BEST!!!!

 

[Carolyn Heath]

Sparky, isn't it nice to put what you have learned from the January 2013 webinar to use? I started to using the internet to search for codes. Eventually, I will start using an encoder like Supercoder or Find-A-Code. Could you post what link you found the complete listing of all HCPCS Level II modifers? Thanks!

 

[Sparky]

Carolyn, I actually found the list on Find-A-Code. Just google "HCPCS Level II Modifier List". It is broken down in sections A; B; and so forth. I looks like a complete list? Maybe Laureen can confirm if that is the complete list.

You are most welcome, I am happy to share!!!

 

[Carolyn Heath]

Thank you!

 

[Sparky]

You are most welcome!!

 

[Sparky]

Carolyn, another option is downloading from CMS.gov the file name is 12anweb (its listed within a zip file); this is 2012 list but I believe they have an updated list for 2013.

 

[Carolyn Heath]

Thank you, Sparky, for another option.

 

[Sparky]

Just wanted to share..................The exam section on HCPCS Level II and Modifiers I had questions about, I am happy to say I passed with no problem. I was sweating it there for awhile, was going to change my answers, so glad I didn't.

 

[Carolyn Heath]

Congratulations, Sparky!

 

[Sparky]

Thank you, Carolyn.