Proper coding of services is critical to ensuring prompt and accurate payment for medical care. KMA can provide assistance with a variety of coding and documentation issues and reimbursement problems.
- Medicare Electronic Billing Resources
- Workgroup for Electronic Data Interchange
- What is 5010?
- What is Consolidated Billing?
Coding & Documentation
Evaluation and Management (E/M) Coding Tips and Resources
- CMS Evaluation and Management (E/M) Guidelines
- CGS Medicare E/M Checklists
- Evaluation and Management – Modifier 25 Payment Reduction
2017 ICD-10-CM and GEMs
2016 ICD-10-CM and GEMs
Medical providers use the Healthcare Common Procedure Coding System for a variety of services.
Level 1 of the HCPCS is comprised of Current Procedural Terminology, a numeric coding system maintained by the American Medical Association. The CPT-4 is used primarily to identify medical services and procedures for which physicians and other health care professionals bill public or private health insurance programs.
Level II of the HCPCS is a standardized coding system that is used primarily to identify products, supplies and services not included in the CPT-4 codes. These include items such as ambulance services and durable medical equipment, prosthetics, orthotics and supplies when used outside a physician’s office.
Both Medicare and Medicaid use the National Correct Coding Edits to ensure correct coding. The Centers for Medicare and Medicaid Services developed the Medically Unlikely Edits, or MUE, to reduce the paid claims error rate for Part B claims. An MUE for a HCPCS/CPT code is the maximum units of service that a provider would report under most circumstances for a single beneficiary on a single date of service. All HCPCS/CPT codes do not have an MUE.
The NCCI "Look-up Tool" will help you to learn how to access and view the NCCI edits and determine proper use for certain modifiers and more.
The NCCI Edits will indicate services that are bundled and cannot be billed separately as well as list services that may be unbundled under certain conditions.
- Questions about modifiers? Use the Modifier Finder Tool
- 2015 Medicare Continue use of Modifier 59
- Medicare Article on Modifier 59
- 2014 Medicare Update Modifier 59
- Medicare Article on Modifier 25