2008 HCPCS Level II

PQRI Drives Most Changes

By Bonnie Schreck, CCS, CPC, CPC-H, CCS-P

HCPCS Level II is the most dynamic code set of all core coding code sets (e.g., CPT®, ICD-9-CM, and HCPCS Level II). This year has proven just that, based on all of the changes: 228 new codes, 45 revised codes, and 223 deleted codes for 2008.

Some of the changes are the development of additional codes for supplies of home monitoring of diabetes (A codes), expansion of radiopharmaceuticals for nuclear medicine diagnostic testing (A and Q codes), and brachytherapy in the C codes (pass-through/new technology codes for the out patient prospective payment system (OPPS).

The largest number of changes are due to the deletion and addition of the G codes (procedures/professional services) for the Physician Quality Reporting Initiative (PQRI). This initiative, implemented on July 1, 2007, is based on the option for physicians to report professional services for a quality data reporting program for services rendered July 1, 2007 to Dec. 31, 2007 with the opportunity for bonus payments.

For 2008, the allowance of additional bonus payments for PQRI has been extended for satisfactory submission of quality data from eligible professionals. Requirements for reporting this data is included in the final rule of the 2008 Medicare Physician Fee Schedule (MPFS). Also identified in this rule are the 119 measures CMS has determined to be appropriate for 2008 data submission. CMS plans to test quality-measures data submission mechanisms based on clinical data registries and electronic health records in 2008. For more information on PQRI, see CMS-1385-FC from the PFS Federal Regulation Notices page of the CMS Physician Fee Schedule section of the CMS website.

The following are some of highlights of the changes to the 2008 HCPCS Level II code set.

As and Bs Expanded

For medical and surgical supplies in the A codes, new codes were added for portable glucose monitoring supplies. Code A4252 is for the blood ketone test or reagent strip. Codes A9276-A9278 allow for the proper reporting of new technology glucose monitoring devices.

Also expanded were codes for the radiopharmaceutical indium In-111. This was to help identify the types of indium In-111 used for different diagnostic purposes. Code A9565 was deleted and A9570-A9572 were added.

In enteral and parenteral therapy, code B4086 expanded into B4087 and B4088 to accommodate for standard or low profile gastrostomy/jejunostomy tubes.

Brachytherapy Changes C Codes

For the pass-through items in the C code section, three brachytherapy codes, C1718, C1720, and C2633 were deleted and eight codes, C2638-C2699, were added that differentiate between stranded and non-stranded brachytherapy sources.

Eight brachytherapy codes, C1716, C1717, C1719, C2616, C2634, C2635, C2636, and C2637, were revised to include the word, “non-stranded” in the description.

For durable medical equipment (E codes), a wheelchair accessory code (E2618) was deleted, and eight codes were added, E0238-E2397.

Of the eleven E code descriptions that were changed, the word “bi-directional” or ”multi-

directional” was removed from six of the static progressive stretch device codes, E1801-E1841.

PQRI Makes G Section Grow

Codes G0375 and G0376 under Procedures/Professional Services, were deleted, and two codes were added in the CPT® code set (99406 and 99407) to identify smoking and tobacco use cessation counseling. Five other non-PQRI codes were deleted, with the remainder of the deletions in the G code section being PQRI codes.

For codes G0380-G0384 for hospital emergency department visits, “department or facility” was changed to “ED.”

The codes added in the G code section include the addition of two codes for alcohol and/or substance abuse structured assessment and intervention (codes G0396 and G0397). The other additions include 115 codes used to identify quality measures in the PQRI program.

Drug Codes See Additions

For the J codes (drugs), J1567 was deleted and four new codes were added that were previously temporary codes (Q codes) to differentiate between the different types of non-lyophilized immune globulin, J1561-J1572.

One code (Q4090) that described intramuscular injection of hepatitis B immune globulin was also deleted

from the Q code section and expanded into two codes to include intravenous injection, J1571 and J1573.

Another deleted drug code is J7319, Hyaluronan or derivative, used for injection into joints to supplement the synovial fluid. In its place, four codes that were Q codes for 2007 were deleted and moved to the J codes. This range is J7321-J7324.

There are three new codes (J7347-J7349) to identify dermal tissue of nonhuman origin, replacing deleted code J7345.

Deleted Albuterol codes J7612, J7613, and J7614 are replaced with two codes, J7602 and J7603.

Another change in the Q code section is the deletion of six codes for low osmolar contrast material (typically used in CT scans) and the addition of three new Q codes (Q9965-Q9967) that combine the concentrates of iodine into larger amounts.

In the V codes (vision codes), one code was added to help report the astigmatism-correcting intraocular lens, V2787.


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