Wiki HCPCS Question---Need to explain to my boss

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EK226

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Hello,

I have a general question about HCPCS codes. I'm auditing some bills that were recently paid, and my boss wants to know what it means when the codes say "Quantity Alert." I'm trying to investigate this further, and need to be able to explain what this means because my boss thinks that we are not paying these correctly.

Here's what I've come up with so far: When I review the Intro section of the HCPCS book it states that Quantity Alert codes report quantities that may not coincide with quantities available in the marketplace and that care should be taken to verify quantities in this code.

It also states that the quanitiy alert codes do not represent Medicare Unlikely Edits (MEUs) and should not be used for MEUs and that an appendix of MEUs can be found in appendix 8.

So when I look at Appendix 8 I see the list of codes w/ quantities attached to them. But am I not supposed to follow this list when it comes to Quantity Alerts because HCPCS codes with a Quantity Alert after it is exempt from this MEU list? I think I'm confusing myself....
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Emily K., CPC
 
I think it just means that extra care should be taken when billing these codes to ensure the units are correct because mistakes are frequently made.
 
that's what I was thinking...that close monitoring should be performed since muliple units can be billed and documentation should support the # of units billed.
 
It means that there is a MUE (medically unlikely edit) limit for that procedure indicating the number of times that cpt can be billed- If you are billing a cpt code that was performed bilaterally and the rules require that it be billed with a 50 instead of Lt, RT, the quanity max will be 1 -indicating that it must be billed with a qty of 1 which means that if it was performed bilaterally, it must be billed with a modifier 50 on one line.

It can also mean that it is a code that cannot be performed bilaterally or where the bilat is part of the definition of the code itself.
 
What it is saying is the unit we buy it in/dispense it in may not be the same as the unit attached to the code.

The example they give is of a DME supply that comes 10 to a pack but they reimburse on an individual basis, not by the pack. So to get paid correctly you have to list the number of units as 10.

Or if it is an injectable we may get something as 50mg per unit but the code is for 25mg per unit. So you would have to use the code x2 to cover the dosage used even though it was only 1 physical unit.

Hope this is helpful,

Laura, CPC, CEMC
 
MMAYCOCK said:
It means that there is a MUE (medically unlikely edit) limit for that procedure indicating the number of times that cpt can be billed- If you are billing a cpt code that was performed bilaterally and the rules require that it be billed with a 50 instead of Lt, RT, the quanity max will be 1 -indicating that it must be billed with a qty of 1 which means that if it was performed bilaterally, it must be billed with a modifier 50 on one line.

It can also mean that it is a code that cannot be performed bilaterally or where the bilat is part of the definition of the code itself.
Click to expand...

What you are saying would be correct if we were discussing CPT codes for procedures, but the OP was referring to HCPCS codes.

Laura, that was a good explanation! Thanks!
 
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