Outpatient Coding Questions

In a joint effort to improve billing and data quality, the American Hospital Association (AHA) and the Centers for Medicare & Medicaid Services (CMS) have joined together in establishing the AHA clearinghouse to handle coding questions on established Healthcare Common Procedure Coding System (HCPCS) usage. The American Health Information Management (AHIMA) will also provide input through the Editorial Advisory Board.

The clearinghouse will serve as a centralized point of contact to educate hospitals, policy makers and the public on HCPCS coding. Hospitals and health care professionals have experienced a growing need for greater consistency and improved understanding of HCPCS coding in the wake of implementation of prospective payment methods that use HCPCS coding for billing and payment purposes.

The AHA's Central Office will handle the clearinghouse functions and provide open access to any person or organization that has questions regarding a subset of HCPCS coding, particularly hospitals and other health professionals who bill under the hospital outpatient prospective payment system (OPPS). Inquiries on the application of level I HCPCS codes (CPT-4) for physicians will be referred to the American Medical Association. Level II HCPCS codes related to durable medical equipment, prosthetics, and other supplies should be referred to the Durable Medical Equipment (DME) Pricing, Data Analysis and Coding (PDAC). The PDAC helps suppliers and manufacturers determine which HCPCS code should be used to describe DMEPOS items for billing Medicare and publishes a Product Classification List (PCL) to their website which includes individual items to code categories. Visit the PDAC website for details.

HCPCS-related questions must be submitted in the approved form, which you can download from the AHA website and either faxed or mailed directly to the AHA Central Office. Be advised that it is difficult to provide coding responses to generic scenarios without specific information. Refer to the form for additional information that should be submitted with your coding question(s).

The mailing address and fax number for HCPCS-related questions are as follows:

AHA Central Office
155 North Wacker Drive, Suite 400
Chicago, IL 60606

Phone: 312-422-3366

Fax: 312-278-0838

For general HCPCS information and coding questions visit the CMS HCPCS - General Information webpage.

 

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