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Supply HCPCS Codes- A6234


Question

We have an observation claim denied with HCPCS A6234 under rev code 272. Medicare states insurance specific non-covd charge on claim.  Our patient did not have surgery therefore I don’t believe 623 is the appropriate code.

Answer

The problem is not the revenue code but the HCPCS code.  In this instance the HCPCS code captures a dressing.  The only time you would report this code on a claim is if you were providing it as a take home supply, in which case, revenue code 623 would be appropriate.  

A-codes that represent supplies should not be reported to Medicare.  This was discussed several years ago in CMS literature.  Unless you have another payer who requires the reporting of these codes for reimbursement purposes, you may want to remove A-codes from your Chargemaster.  This supply in question should be reported under revenue code 272 without a HCPCS code.

Disclaimer: All articles intended for general consumption only and not as a recommendation for a specific situation. Readers should consult an official source (AHA, AMA, etc.) or a qualified attorney for specific legal guidance.
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