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The Coder’s Toolbox


By Linda Templeton, CPC, CPC-H, CCS-P
We all know how frustrating it is to complete a project when you don’t have the right tools. The most skilled in a trade find themselves collecting so many tools that it’s hard to remember where the most basic and useful items are. As coders, we are bombarded with so many resources that we are overwhelmed and frustrated with information overload.
The Centers for Medicare and Medicaid Services’ (CMS) and Medicare carriers’ Web sites are a coder’s perfect set of tools. With a little searching and determination, you’ll be surprised to find that most everything you need to know about coding and submitting claims correctly is right there at your fingertips.
I find that keeping my resource “toolbox” down to the basic essentials minimizes my frustration. With the vast amount of coding and billing resources available, we can’t be certain of getting the most accurate information. My advice to new coders is to go back to CMS resources and confirm any information obtained from other sources.
My favorite CMS web tools to use are the following:

Physician Fee Schedule Look-up

This is an excellent resource. With this tool, we can research a specific HCPCS Level II or CPT® code and find pricing amounts, various payment policy indicators, relative value units (RVUs), and geographic practice cost indexes (GPCIs) by a single procedure code, a range of codes, and a list of procedure codes. With this tool you can also find information regarding global days for surgical procedures and physician supervision requirements. All of this information is at one location and alleviates the task of searching several areas to obtain the information you are seeking.
To access this tool, follow these steps:

  • Go to www.cms.hhs.gov/PFSlookup/.
  • Select “Physician Fee Schedule Search” on the menu to the left of the page.
  • Read the instruction sheet titled “Help with Physician Fee Schedule Search” to guide you until you are familiar with the tool.

NCCI Policy Manual for Part B Medicare Carriers, and NCCI Edits

Most of us are familiar with the National Correct Coding Initiative (NCCI) edit tables. However, not as many of us are familiar with the NCCI Policy Manual as a source of coding information for a particular specialty. It’s a great resource for NCCI or “bundling” edits, and the chapter guidelines provide detailed information of the rationale behind the edits. I print this out each year and create a binder organized by CPT® section that I can use for reference. You may prefer to save it to your desktop or add it to your “Favorites” or “Bookmarks” for handy reference.
I recommend reading chapter 1 of the NCCI Policy Manual prior to interpreting the NCCI edit tables. This chapter provides an easy-to-understand explanation of how to interpret the tables and the rationale behind the edits. To find the Policy Manual, follow these steps:

  • Go to www.cms.hhs.gov.
  • Select the Medicare tab on the top-left portion of the web page.
  • Scroll down to the “Coding” section.
  • Click the National Correct Coding Initiative Edits link.
  • Scroll down to the “Downloads” section and select NCCI Policy Manual for Part B Medicare Carriers.
  • Open the zip file and select CHAP1final083107.
  • Under the “Related Links Inside CMS” section, you can browse through NCCI FAQs to find some interesting questions and answers about related topics.

The remaining chapters provide coding guidelines relating to specialties, and correspond with the chapters of the CPT®. For hospital outpatient prospective payment system (OPPS) setting, see the hospital center and NCCI Edits for OPPS.

Medicare Coverage Center

Having a good understanding of the coverage guidelines specific to your specialty services is essential to your practice or facility. You can access the local coverage decisions (LCD) and national coverage decisions (NCD) that relate to your specific area of coding.
The Medicare Coverage Database provides several ways to locate and view data. Here are a few you may find useful:

  • Indexes. Provide users with pre-defined lists of national and local coverage documents.
  • Searches. Allows users to search both the NCD and LCD databases using a variety of criteria such as key word, coverage topic, and date.
  • Reports. Provides users with reports of national and local coverage data.
  • Downloads. Allows users to download complete sets of LCDs and articles and the complete set of NCDs.

Open Door Forums

The CMS Open Door Forum is a free teleconference allowing the provider community to participate in live discussions with CMS. They provide a place for providers and CMS to help identify and clarify issues for resolution. Here, relevant issues to providers can be discussed with CMS officials and other colleagues in your area. The Open Door Forums are held every four to six weeks with 16 ongoing forums in specialized topic areas.
The participants learn from this dialogue to clarify surrounding coverage, coding and payment. Comments can be submitted to the panel before the sessions. To participate in the event, register and sign up to receive email notifications prior to each forum discussion.
For more information and to sign up for email notifications, go to Open Door Forums on the CMS website.
Archived forums area available if you miss the live presentation, or if you want to review the presented information at a later date.
Besides using the above CMS website resources, you should become familiar with your local carrier website for the most current coding information. When it’s time to clean out your coding toolbox, the CMS webssite is definitely the tool to keep!

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