Reimbursement 101 2011 - Cardinal Health

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Reimbursement Terminology 4 • HCPCS Codes (billing ( g codes) ) - Healthcare Common Procedure Coding System • Standardized method for healthcare providers and medical suppliers to bill insurance programs for medical services, procedures and supplies furnished to patients patients. © Copyright 2011, Cardinal Health, Inc. or one of its subsidiaries. All rights reserved.
Reimbursement Terminology 5 • HCPCS is divided into 2 principal subsystems: – LLevel l I – CPT (Current (C PProcedural d l TTerminology) i l ) – UUsed d primarily i il to identify medical services and procedures furnished to patients by healthcare providers. These are five digit numerical codes assigned and maintained by the American Medical Association Example: 78306 – W/B Bone scan – Level II – HCPCS/National codes – Identifies products, supplies and services not included in the CPT Codes. These are five digit alphanumeric codes assigned and maintained by CMS (radiopharmaceuticals and drugs) Examples: A9500-Tc99m sestamibi, per dose; J1245 – dipyridamole, per 10mg © Copyright 2011, Cardinal Health, Inc. or one of its subsidiaries. All rights reserved.
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Page 23 and 24: Coverage • Most important issue i
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Page 27 and 28: Coverage - Medicare A service or pr
Page 29 and 30: Coverage - Medicare 29 • In gener
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Page 33 and 34: PET Coverage > Medicare Medicare Na
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Page 37 and 38: Coding 37 • ICD-9-CM - Internal C
Page 39 and 40: Coding 39 CPT/HCPCS codes • The n
Page 41 and 42: Coding Modifiers • Two character
Page 43 and 44: Coding - Hospital Revenue Codes •
Page 45 and 46: Coding > Claim Forms • Hospitals
Page 47 and 48: Coding > Claim Form 1450 (Hospital)
Page 53 and 54: Coding > Claim Form 1500 Clinic/Phy
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NM Reimbursement 101 - References 5
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Nuclear Medicine Reimbursement 101
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Reimbursement 101 2011 - Cardinal Health

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