Have You Checked the HCPCS Corrections File? Lab Coders, I’m Looking at You

HCPCS corrections 2017

If you code for drug testing, retinal prostheses, or seat lift mechanisms, the HCPCS 2017 corrections document has some items of interest aimed directly at you.

Where Is the HCPCS Corrections File?

The CMS website includes an Alpha-Numeric HCPCS page. You can download the current code set as well as a couple of the past code sets from this page.

For 2017, one of the file options is for 2017 Corrections to the Alpha-Numeric HCPCS File.

What Is in the HCPCS Corrections File?

At the time of this posting, the corrections file includes this information, effective Jan. 1, 2017 (check the 2017 corrections file linked above for complete details):

  • Add C1842 (Retinal prosthesis, includes all internal and external components; add-on to C1841). The HCPCS Coverage Code listed is D, which indicates special coverage instructions apply.
  • Remove cross reference codes Q0078-Q0080 (deleted long ago) from current seat lift mechanism codes E0627-E0629.
  • Terminate presumptive drug test codes G0477-G0479. Remember that CPT® 2017 added new drug testing codes with descriptors almost identical to G0477-G0479.
  • Revise the long descriptors for definitive drug test codes G0480-G0483 (see next section).
  • Add G0659 (Drug test[s], definitive, utilizing drug identification methods able to identify individual drugs and distinguish between structural isomers [but not necessarily stereoisomers], including but not limited to GC/MS [any type, single or tandem] and LC/MS [any type, single or tandem], excluding immunoassays [e.g., IA, EIA, ELISA, EMIT, FPIA] and enzymatic methods [e.g., alcohol dehydrogenase], performed without method or drug-specific calibration, without matrix-matched quality control material, or without use of stable isotope or other universally recognized internal standard[s] for each drug, drug metabolite or drug class per specimen; qualitative or quantitative, all sources, includes specimen validity testing, per day, any number of drug classes). The coverage code is C, meaning carrier judgment. The pricing indicator 21 tells you the price is subject to the national limitation amount.

What Changes in the G0480-G0483Descriptors?

In the descriptor for new code G0659, you see the wording “performed without method or drug-specific calibration, without matrix-matched quality control material, or without use of stable isotope or other universally recognized internal standard(s).”

Keep that in mind when you review the main change to the descriptors for G0480-G0483, which references the use of universally recognized internal standards and quality control.

Because the descriptors all start out the same, you can get an idea of all the changes by looking at how the old and new descriptors for G0480 compare. Bold in the descriptors shows where the wording and formatting differs between the original HCPCS 2017 file and the corrections file.

G0480 descriptors:

  • Original file: Drug test(s), definitive, utilizing drug identification methods able to identify individual drugs and distinguish between structural isomers (but not necessarily stereoisomers), including, but not limited to gc/ms (any type, single or tandem) and lc/ms (any type, single or tandem and excluding immunoassays (e.g., ia, eia, elisa, emit, fpia) and enzymatic methods (e.g., alcohol dehydrogenase)); qualitative or quantitative, all sources(s), includes specimen validity testing, per day, 1-7 drug class(es), including metabolite(s) if performed
  • Corrections file: Drug test(s), definitive, utilizing (1) drug identification methods able to identify individual drugs and distinguish between structural isomers (but not necessarily stereoisomers), including, but not limited to GC/MS (any type, single or tandem) and LC/MS (any type, single or tandem and excluding immunoassays (e.g., IA, EIA, ELISA, EMIT, FPIA) and enzymatic methods (e.g., alcohol dehydrogenase)), (2) stable isotope or other universally recognized internal standards in all samples (e.g., to control for matrix effects, interferences and variations in signal strength), and (3) method or drug-specific calibration and matrix-matched quality control material (e.g., to control for instrument variations and mass spectral drift); qualitative or quantitative, all sources, includes specimen validity testing, per day; 1-7 drug class(es), including metabolite(s) if performed.

How About You?

Do you use the codes in the corrections file? What do you think about the changes?

About 

Deborah concentrates on coding and compliance for radiology and cardiology, including the tricky world of interventional procedures, as well as oncology and hematology. Since joining The Coding Institute in 2004, she’s also covered the ins and outs of coding for orthopedics, audiology, skilled nursing facilities (SNFs), and more.

, , , ,

2 Comments For This Post

  1. Dan Medders Says:

    Hello, Ms. Marsh. Your article helped to point me toward the CMS link to the Corrections. Thanks for that. As much as I try to get notified by CMS when these Corrections get published, I somehow manage to not get them when I need them! But I noticed in your article that you refer to “G0569”. Should it be “G0659”?

  2. Deborah Marsh Says:

    Hi, Dan – You are absolutely right. I’ve revised the post to refer to G0659. My goal is to always give accurate information, but I admit I laughed when I realized I was correcting a post about a corrections document. That will keep me humble 🙂 Thank you very much for letting me know!

Leave a Reply