Supply/Implant HCPCS Resources

Good morning,

I am wondering if anyone can share any resources they use to assign HCPCS to supply/implant items?

Larger vendors/manufacturers such as Medtronic, Boston Scientific, etc. have reimbursement information online - or a department specifically to help with reimbursement questions. I run into issues with smaller vendors who don't have dedicated resources/departments to help facilities with setting up new supply/implant items correctly for billing and reimbursement. Also, with lesser known items, and especially spinal items.

I do utilize another system that helps with Interventional and Cardiology items, but I will be losing that resource Oct 1 also and am just trying to find something to take it's place.

Any information would be helpful! Thank you in advance. 

Comments

  • One helpful document is from CMS. It lists the device categories along with the definitions of what is grouped into that category. While it is not supplier specific, it has been helpful in assigning codes. You may need to have a discussion with internal staff or the supplier regarding the characteristics and uses of the device, but I have found it to be very helpful. You can find it at:

    https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/HospitalOutpatientPPS/Downloads/Complet-list-DeviceCats-OPPS.pdf

  • We utilize Vitalware at our facility.  We also use online coding guides from vendors as a reference, as you have suggested.

  • Nthrive and vitalware are the best resources for general information on services and supplies.

    There is no short answer or resource that I am aware of. I rely on highly experenced chargemaster staff (certified coders) to assign the codes.

  • We appreciate the larger vendors providing guidance on HCPCS codes for their devices. Many smaller vendors have representatives that can provide guidance, just not an organized department for that work. Most local vendor representatives are helpful in providing contacts for reimbursement discussions. We also utilize Optum's Coder's Desk Reference for HCPCS Level II and discussion with clinical experts who provide clear information on the device and its use in the clinical areas

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