SGD Coding - AACFundingHelp



SGD Coding

Coding is one a way benefits programs can keep track of utilization of specific medical services, including items of durable medical equipment. Some programs, like Medicare, also use codes as a way to develop payment rates.

Historically, Medicaid programs issued state-specific codes for SGDs, or, considered them under a “miscellaneous items” code, commonly known as E-1399. These state specific codes were needed because the most frequently used coding system known as HCPCS, developed for and applied by Medicare, had never assigned any codes to SGDs.

Coding has gotten much attention recently because as of 2004, all Medicaid programs have been required to replace their state-specific codes with HCPCS codes, resulting in a uniform coding system for use by Medicaid and Medicare. (NOTE: that both programs must apply the same codes does not mean Medicaid also must follow Medicare regarding DME pricing. Medicaid programs are under no such obligation.)

What Is “HCPCS?”

HCPCS, pronounced “hick-picks” stands for the Healthcare Common Procedure Coding System. This acronym also had been known as the Health Care Financing Administration (HCFA) Common Procedure Coding System. (The renaming of the acronym occurred after HCFA was renamed the Centers for Medicare & Medicaid Services (CMS) in 2001.)

HCPCS is a classification system for items of durable medical equipment, orthotic and prosthetic devices, and medical supplies.

A HCPCS code consists of a letter prefix, followed by a four digit number. The prefix “E” is assigned to items of durable medical equipment.

How are HCPCS Codes Assigned?

HCPCS codes are assigned by a panel of CMS staff, called the HCPCS Alpha-Numeric Editorial Panel. The panel reviews applications for new codes that are submitted by interested parties, such as device manufacturers or suppliers, and they can be assigned by CMS staff as part of coverage policy review. For AAC devices or SGDs, both procedures were followed.

DME HCPCS codes are assigned for equipment that meet the Medicare definition of durable medical equipment:

Items that have the following characteristics:

1. are able to withstand repeated use;

2. are primarily and customarily used to serve a medical purpose;

3. are generally not useful to an individual in the absence of illness or injury; and

4. are suitable for use in the home.

42 C.F.R. § 414.202.

Codes are assigned to groups of devices, rather than to specific models. Code assignments are based on the physical, functional and operational characteristics of the equipment, meaning that each code will have multiple equipment models with similar features. Because many device types have many different models, with different features, characteristics, target users, and prices, a range of codes may be assigned to a family of devices, as was done for AAC devices or speech generating devices.

AAC Device or Speech Generating Device Codes

History

Prior to January 1, 2000 AAC devices or speech generating devices had not been assigned any HCPCS codes. (Before January 1, 2001, Medicare did not cover these devices, and at that time, Medicaid programs used their own state-based codes.)

E-1900 – the first code

As of January 1, 2000, one HCPCS code became effective. HCPCS Code “E 1900” was assigned to “synthesized speech output communication aids with dynamic displays.” This code was awarded upon a manufacturer-submitted request filed in the Spring of 1999.

The Formal Request Coding Proposal

In December 1999, the Formal Request for National Coverage Decision for Augmentative and Alternative Communication Devices was submitted to Medicare in support of its review of AAC device coverage policy. The Formal Request included a comprehensive AAC device coding proposal. It acknowledged that the E 1900 code was not sufficient to classify all AAC devices. Instead, the Formal Request included a proposal for three AAC device codes:

Code 1 AAC devices with digitized speech output;

Code 2 AAC devices with synthesized speech output which (a) require message formulation by spelling , and (b) require access by physical contact directs election; and

Code 3 AAC devices with synthesized speech output which permit multiple methods of message formulation and multiple methods of access. (This code will include all AAC devices covered by HCPCS Code E 1900.)

Also, although “Code 1” described all digitized speech output devices, the Formal Request proposed that this code include 5 sub-divisions, reflecting different amounts of recording time among these devices. The time divisions initially proposed were:

Digitized speech output devices with less than 4 minutes of recording time

Digitized speech output devices with 4 – 8 minutes of recording time

Digitized speech output devices with 9-16 minutes of recording time

Digitized speech output devices with 17-32 minutes of recording time

Digitized speech output devices with more than 32 minutes of recording time.

In addition, five additional codes were proposed for “access technologies; mounting systems; supplemental power sources; carrying cases and AAC software.”

The complete Formal Request is posted for review at funding.html.

Initial HCPCS Codes for Speech Generating Devices

In November 2000, Medicare released its new speech generating device coverage policy. As part of that policy, Medicare announced the coding scheme it was going to adopt for SGDs. It accepted the 2 codes proposed in the Formal Request for synthesized speech output devices, but revised the proposal for digitized devices and for AAC software, mounts and accessories.

Digitized speech output devices were split into 2 codes, instead of the single code plus 5 recording time-based sub-divisions proposed in the Formal Request. However, consistent with the Formal Request’s proposal, Medicare divided the codes by the devices’ amount of recording time.

Medicare also simplified the proposed codes for related AAC device items. Instead of the 5 codes proposed, Medicare adopted 3: one each for AAC software, mounts and accessories.

Original Medicare Codes Effective January 1, 2001

|K0541 |Speech generating device, digitized speech, using pre-recorded messages, less than or equal to 8 minutes |

| |recording time. |

|K0542 |Speech generating device, digitized speech, using pre-recorded messages, greater than 8 minutes recording time.|

|K0543 |Speech generating device, synthesized speech, requiring message formulation by spelling and access by physical |

| |contact with the device. |

|K0544 |Speech generating device, synthesized speech, permitting multiple methods of message formulation and multiple |

| |methods of device access. |

|K 0545 |AAC software |

|K 0546 |AAC device mounts |

|K 0547 |AAC device accessories |

The “K” prefix assigned to these codes denote them as “temporary.”

First Coding Revision: Revisiting Digitized Speech Output Devices

In 2003, Medicare revised the codes assigned to digitized speech output devices. It split the K 0542 code, consisting of digitized speech output devices with recording times of greater than 8 minutes of recording time into 3 codes:

K 0615 Speech generating device, digitized speech, using pre-recorded messages, with greater than 8 but less than or equal to 20 minutes of recording time

K 0616 Speech generating device, digitized speech, using pre-recorded messages, with greater than 20 but less than 40 minutes of recording time.

K 0617 Speech generating device, digitized speech, using pre-recorded messages, with greater than 40 minutes of recording time

As a result of this change, Speech Generating Devices, software, mounts and accessories were the subject of 9 HCPCS codes.

Second Coding Revision: Substitution of E – Codes for K- Codes

In 2004, Medicare changed the code prefix and numbers for SGDs. The temporary code prefix “K” was replaced by “E” which denotes items of durable medical equipment. And, a new sequence of four digit numbers was assigned to the 9 SGD codes.

These changes represent label changes only: no substantive changes were made to the code definitions or to the devices that fit within each one. These 9 codes remain in effect today:

|E 2500 |Speech generating device, digitized speech, using pre-recorded messages, less than or equal to 8 |

| |minutes recording time. |

|E 2502 |Speech generating device, digitized speech, using pre-recorded messages, with greater than 8 but less |

| |than or equal to 20 minutes of recording time |

|E 2504 |Speech generating device, digitized speech, using pre-recorded messages, with greater than 20 but less |

| |than 40 minutes of recording time. |

|E 2506 |Speech generating device, digitized speech, using pre-recorded messages, with greater than 40 minutes |

| |of recording time |

|E 2508 |Speech generating device, synthesized speech, requiring message formulation by spelling and access by |

| |physical contact with the device. |

|E 2510 |Speech generating device, synthesized speech, permitting multiple methods of message formulation and |

| |multiple methods of device access |

|E 2511 |AAC software |

|E 2512 |AAC device mounts |

|E 2599 |AAC accessories |

................
................

In order to avoid copyright disputes, this page is only a partial summary.

Google Online Preview   Download