Outpatient Coding Questions

In a joint effort to improve billing and data quality, the American Hospital Association (AHA) and the Centers for Medicare & Medicaid Services (CMS) have joined together in establishing the AHA clearinghouse to handle coding questions on established Healthcare Common Procedure Coding System (HCPCS) usage. The American Health Information Management (AHIMA) will also provide input through the Editorial Advisory Board.

The clearinghouse serves as a centralized point of contact to educate hospitals, policy makers and the public on HCPCS coding. Hospitals and health care professionals have experienced a growing need for greater consistency and improved understanding of HCPCS coding in the wake of implementation of prospective payment methods that utilize HCPCS coding for billing and payment purposes.

The AHA’s Central Office handles the clearinghouse functions and provide open access to any person or organization that has questions regarding a subset of HCPCS coding, particularly hospitals and other health professionals who bill under the hospital outpatient prospective payment system (OPPS). Inquiries on the application of level I HCPCS codes (CPT-4) for physicians will be referred to the American Medical Association. 

Level II HCPCS codes related to durable medical equipment, prosthetics, orthotics, and other supplies should be referred to the Statistical Analysis Durable Medical Equipment Regional Carriers (SADMERC). The SADMERC is responsible for providing suppliers and manufacturers with assistance in determining which HCPCS code should be used to describe DMEPOS items for the purpose of billing Medicare. The SADMERC has a toll free helpline for this purpose, (877) 735-1326, which is operational during the hours of 9 a.m. to 4 p.m. ET. In addition, the SADMERC publishes a product classification list on its website that lists individual items to code categories. 

HCPCS-related questions must be submitted in the approved form, which you can download from the AHA website at http://www.ahacentraloffi ce.org, and either faxed or mailed directly to the AHA Central Offi ce. Be advised that it is difficult to provide coding responses to generic scenarios without specific information. Refer to the form for additional information that should be submitted with your coding question(s). 

The mailing address and fax number for HCPCS-related questions are as follows: 

Central Office on HCPCS 

American Hospital Association

 One North Franklin 

Chicago, IL 60606 

Fax: 312-422-4583