The Durable Medical Equipment Medicare Administrative Contractors (DME MACs) have issued a Correct Coding article on “HCPCS Coding Recommendations from Non-Medicare Sources,” which discusses Medicare supplier responsibility for selecting the most appropriate Healthcare Common Procedure Coding System (HCPCS) code for furnished medical products. The DME MACs point out that manufacturers and other entities do not have authority to assign their own code determinations to specific products. While manufacturers may suggest unofficial coding "recommendations," the DME MACs caution that "such recommendations have no official status and, in the event of a claim review, may result in an incorrect coding claim denial" (unless those recommendations are backed up by an authoritative coding determination by the Pricing, Data Analysis, and Coding (PDAC) contractor). Likewise, such unofficial manufacturer coding recommendations "are not helpful in defense of an incorrect coding claim denial during the appeals process." The publication also reminds suppliers that that "[s]electing a code based upon the fee schedule almost always results in an incorrect coding determination." The document offers a series of recommendations for determining the most appropriate HCPCS code, including consulting PDAC Product Classification Lists, DME MAC coding bulletins, and policy articles accompanying local coverage determinations and reviewing the detailed "long" HCPCS code descriptors.
This article is presented for informational purposes only and is not intended to constitute legal advice.
