Results 1 to 8 of 8

HCPCS Question---Need to explain to my boss

  1. #1
    Default HCPCS Question---Need to explain to my boss
    Exam Training Packages
    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....
    __________________
    Emily K., CPC

  2. #2
    Default
    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.
    Walker Bachman, CPC, CPPM

  3. #3
    Default
    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.

  4. Default
    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.

  5. #5
    Default
    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

  6. #6
    Default
    Quote Originally Posted by MMAYCOCK View Post
    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 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!
    Walker Bachman, CPC, CPPM

  7. Default
    I apologize. I misread the question. Laura, your explanation is great.

  8. #8
    Default
    Quote Originally Posted by MMAYCOCK View Post
    I apologize. I misread the question. Laura, your explanation is great.
    No sweat... I do it all the time
    Walker Bachman, CPC, CPPM

Similar Threads

  1. Help!! 92235 and unreasonable boss
    By losborn in forum Ophthalmology/Optometry
    Replies: 1
    Last Post: 10-26-2012, 10:16 AM
  2. Boss wants an Answer
    By strwberry239 in forum Medical Coding General Discussion
    Replies: 3
    Last Post: 07-17-2009, 10:18 AM
  3. Carpal Boss Excision
    By coderguy1939 in forum Orthopaedics
    Replies: 10
    Last Post: 04-16-2009, 03:55 PM
  4. EM Question Please Explain
    By Sott3935 in forum Medical Coding General Discussion
    Replies: 4
    Last Post: 03-06-2009, 04:37 PM
  5. carpometacarpal boss dorsum
    By abevan in forum Orthopaedics
    Replies: 3
    Last Post: 10-05-2008, 09:15 AM

Posting Permissions

  • You may not post new threads
  • You may not post replies
  • You may not post attachments
  • You may not edit your posts
  •  
Enjoying Our Forums?

AAPC forums are a benefit of membership. Joining AAPC grants you unlimited access, allowing you to post questions and participate with our community of over 150,000 professionals.

Join Now Continue Reading Without Full Access

Already a Member?

Login

Close Message

In addition to full participation on AAPC forums, as a member you will be able to:

  • Access to the largest healthcare job database in the world.
  • Join over 150,000 members of the healthcare network in the world.
  • Be a part of an industry leading organization that drives the business side of healthcare.
  • Save anywhere from 10%-50% with exclusive member discounts on courses, books, study materials, and conferences.
  • Access to discounts at hundreds of restaurants, travel destinations, retail stores, and service providers. AAPC members also have opportunities to save on heath, life, and liability insurance.
  • Become a member of a local chapter and attend regular meetings.