PCS Job Code Changes


Effective June 1, 2011, the PCS and PCS-Plus programs will end, and be replaced by two new In-home care (IHC) programs.  The memo from CCME regarding this is available at
http://www.thecarolinascenter.org/documents/IHCInformationSheetforProviders201105v.3.pdf

Basically, the billing process is the same, but the codes used for services will change.  The HCPCS code will still be S5125, but with modifiers to identify whether the patient is under 21 years old or not. (HA is child/under 21, HB is adult/over 21)

In order to implement this change in Barnestorm, you need to do three things:
(1) make sure the patient’s date of birth is correct;
(2) set up a new job code for IHCC with HCPCS = S5125 and modifier HA, a start date of 6/1/11 and the same rate you currently charge for PCS;
(3) set up a new job code for IHCA with HCPCS = S5125 and modifier HB, a start date of 6/1/11 and the same rate you currently charge for PCS.

Before June 1, you will continue to bill using PCS and PCS-Plus codes:
Service     Code     Modifier     Description     End Date
PCS     S5125     None     Up to 60 hours per month     May 31, 2011
PCS-Plus     99509     None     More than 60 hours per month     May 31, 2011

After June 1, you will bill using IHC codes:
Service     Code     Modifier     Description     Effective Date
IHCC     S5125     HA     Attendant Care Services; per
15 minutes     June 1, 2011
IHCA     S5125     HB     Attendant Care Services; per
15 minutes     June 1, 2011

As charges are being keyed, the patient’s age on the date of service will be used to match against the modifier HA or HB to make sure the correct job code is being used, and to make sure that either HA or HB is being used.  This only applies to payer codes with a Format = E, which will still be used to identify PCS/IHC patients.

Posted Wednesday, June 08, 2011 by christine@barnestorm.com
http://kb.barnestorm.biz/KnowledgebaseArticle50674.aspx