Author Question: The HCPCS codes are most often used for billing Medicare claims but may also be used for Medicaid ... (Read 112 times)

audie · **on:** Jun 27, 2018

The HCPCS codes are most often used for billing Medicare claims but may also be used for Medicaid claims and for some private insurance carriers. Identify and describe the three levels of coding used in this system.

What will be an ideal response?

Question 2

Using the CMS-1500 form, examiners become familiar with the various blocks and start to know where to obtain the information required for completing and processing claim forms. Identify, explain, and describe in list form the various uses of the blocks followed by an in-depth description of the Information about the Patient block.

What will be an ideal response?

brittiany.barnes · **Reply #1 on:** Jun 27, 2018

Answer to Question 1

Answer:
Level I utilizes the current CPT codes for most procedures.
Level II utilizes the HCPCS codes listed in the HCPCS manual.
Level III utilizes codes which are specific to the local Medicare/Medicaid carrier. Level III codes were discontinued on December 31, 2003.
One way to code using the HCPCS system is to check Level II codes first and then go to the CPT manual. Another way is to go to the CPT codes first and then the HCPCS; it depends on the type of coding being done.

Answer to Question 2

Answer:
Since it is easier to remember information in groups, the CMS-1500 is broken into sections for understanding. These sections include information about the patient, the insured, the secondary insurance, third party liability, authorization signature, the illness, the procedures performed, and the provider of services.
Information about the Patient
These blocks contain information about the patient.
1. Medicare, Medicaid, TRICARE, CHAMPVA, Group Health Plan, FECA, Black Lung, or Other. Check the box of the organization to which you are submitting this claim for payment.
2. Patient's Name. Enter patient name.
3. Patient's Birth Date and Sex. All dates should be recorded as Month/Day/Year, i.e., 01/13/2012. Check the box for the appropriate sex.
5. Patient's Address, City, State, ZIP Code, and Phone Number. Enter address.
6. Patient's Relationship to Insured. Spouse, self, etc.
8. Patient's Status. Check applicable boxes.