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Can these CPT codes be billed together?

Many procedure codes should not be reported together because they are mutually exclusive of each other. Mutually exclusive procedures cannot reasonably be performed at the same anatomic site or same beneficiary encounter.

How is medical coding done?

Medical coding is the translation of medical reports into a shortcode used within the healthcare industry. After a medical provider examines or treats a patient, the insurance company needs to understand what was done in order to process the bill.

Which coding reference is published by CMS?

The Centers for Medicare & Medicaid Services (CMS) has updated its Healthcare Common Procedural Coding System (HCPCS) Level II coding procedures to enable shorter and more frequent HCPCS code application cycles.

What are the steps to proper CPT coding?

The correct process for assigning accurate procedure codes has six steps: (1) review complete medical documentation; (2) abstract the medical procedures from the visit documentation; (3) identify the main term for each procedure; (4) locate the main terms in the CPT Index; (5) Verify the code in the CPT main text; and …

What is the difference between modifier 51 and 59?

Modifier 51 impacts the payment amount, and modifier 59 affects whether the service will be paid at all. Modifier 59 is typically used to override National Correct Coding Initiative (NCCI) Edits.

Who is the clearinghouse for HCPCS coding questions?

The American Hospital Association (AHA) and the Centers for Medicare & Medicaid Services (CMS) have joined together in establishing the AHA clearinghouse to handle coding questions on established HCPCS usage. The American Health Information Management (AHIMA) also provides input through the Editorial Advisory Board.

What is Level 1 of the HCPCS coding system?

Level I of the HCPCS is comprised of Current Procedural Terminology (CPT-4), a numeric coding system maintained by the American Medical Association (AMA).

When did CMS standardize reason codes and statements?

In 2015 CMS began to standardize the reason codes and statements for certain services. As a result, providers experience more continuity and claim denials are easier to understand.

What is the HCPCS email address for Medicare?

Because Medicare and other insurers cover a variety of services, supplies, and equipment that are not identified by CPT-4 codes, the level II HCPCS codes were established for submitting claims for these items. HCPCS Email Address: [email protected]