Allegheny Messages

We’ve been getting a lot of calls recently concerning the use of the new ‘G’ HCPCS codes for Medicare. In the past, for Medicare billing, one revenue code usually had a HCPCS code associated with it. For example, for 551 skilled nursing had a HCPCS code of G0154. All you had to do is set up the HCPCS code for each service in services maintenance. Every time a bill was created, the HCPCS code was pulled from the services setup. If the user wanted to use a HCPCS code on a visit that was different than the revenue code setup they could enter the code on the visit screen for a particular visit. A HCPCS code in the visit screen would override the service setup. Hospice users have been used to this because they have had to have a HCPCS code on each rountine charge; the HCPCS code reflects where the patient was seen on that date.

The way we currently see it for Medicare, the patient visits could have different HCPCS codes on different days for the same service, especially for nursing and to a lesser extent for therapy. We felt it would be better for HCPCS codes to be used and appear on the visits screen for nearly every visit. When a visit is being entered, once the insurance company and revenue code is entered, the system will do a search and pull in the default HCPCS code. The user will then be able to override that HCPCS code. For example if G0154-Skilled Nursing Service is the default for skilled nursing, G0154 will automatically come into the visit screen. The user can then change the code to G0164-RN/LPN Training/Education. A HCPCS search box has been added to the visit screens beside the current HCPCS box to help users select the correct HCPCS code.

We also added a default HCPCS code on the employee screen. This field will also pull into the visit screen. This new field might be useful for therapy assistants because we believe they will always use the same HCPCS code. We would not recommend using this field for nurses or therapists.

Finally, on the PPS Billing Review Form that you can print under PPS Billing, where it lists all the visits on the bottom of the form, we are now also displaying the HCPCS code along with a short description of the code for each visit.

These changes will be available on tonight’s update, Version 4700. Similiar changes will be available to our clinical users in the very near future (along with a major update that we have been working on for some time). We also will be talking to some agencies in the near future and might modify our approach based upon their input.

We thank you for your help and support with these changes.