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Harness the Power of Crosswalks

Harness the Power of Crosswalks

These underutilized tools enable coders to work smarter, not harder.

As medical coders, we are always looking for tips and tricks — anything to make our job functions more efficient. One of the most exhausting parts of coding charts is not knowing what ICD-10-CM code we should use for a specific CPT® code. Did you know that a crosswalk can help you with that?

What Are Crosswalks?

I ran a poll on LinkedIn asking how many of my contacts use crosswalks. I was highly surprised to learn 60 percent of those who voted said they do not know what a crosswalk is!

A medical coding crosswalk can take a code from any code set and assist in matching up the equivalent codes in a different code set. While the crosswalks are not a guarantee of payment, they can assist coders in accurate code selection. For example, let’s say you are coding CPT® 69210 Removal impacted cerumen requiring instrumentation, unilateral, but you are not sure which ICD-10-CM codes are appropriate. Simply type 69210 into the crosswalk and the applicable ICD-10-CM codes appear. If you are using Codify by AAPC, the results shown in Figure A will populate in the crosswalk widget.

As stated, crosswalks do not guarantee payment. For example, your insurance carrier may not cover ICD-10-CM H61.20 Impacted cerumen, unspecified ear due to the unspecified ear laterality; however, the laterality specifications are included in the crosswalk widget.

You may perform the reverse of this crosswalk as well! If you refer to Figure A, you will notice there is a radio button next to ICD-10-CM. Simply click on this icon.

Crosswalk Examples

There are crosswalks in place to find substitutions for codes, as well. For example, a Medicare patient presents for a screening colonoscopy. You know that CPT® 45378 Colonoscopy, flexible; diagnostic, including collection of specimen(s) by brushing or washing, when performed (separate procedure) is a diagnostic colonoscopy, but the screening colonoscopy codes are HCPCS Level II codes for Medicare. If you enter 45378 into the CPT® to HCPCS crosswalk, the information shown in Figure B will populate in the results.

This crosswalk can also be executed in reverse by keying in the HCPCS Level II code to locate the CPT® codes that are most appropriate.

Another crosswalk that I find immensely helpful is the Local Coverage Determination (LCD) crosswalk. You can search by CPT®/HCPCS Level II code, LCD/Article Title, and LCD/Article ID, and refine by state or ZIP code. This tool really comes in handy when you work for an organization that has providers in multiple states and different Medicare Administrative Contractors (MACs).

For example, in searching CPT® 90715 Tetanus, diphtheria toxoids and acellular pertussis vaccine (Tdap), when administered to individuals 7 years or older, for intramuscular use, the state of Indiana follows under the Wisconsin Physicians Service (WPS) jurisdiction and will allow a TDaP vaccine to be administered as a Medicare Part B service when a patient presents initially for an injury. The state of Kentucky falls under multiple MACs in different areas, one of those including WPS for this specific policy; however, Kentucky Medicare does not allow for a TDaP vaccine to be covered under Medicare Part B benefits. By using the LCD crosswalk, you have access to all this information, plus the links to the Local Coverage Analysis (LCA) articles.

The crosswalks do not stop there! Within Codify, you have access to these additional crosswalks:

  • CPT® to ICD-9
  • NCD Lookup
  • ICD-9 to ICD-10
  • ICD-9 to DRG
  • DRG to ICD-9 Vol. 1, IPPS
  • CPT® to Revenue Codes
  • CPT® to Modifier
  • CPT® to Anesthesia
  • DRG to ICD-9 Vol. 3, IPPS
  • Superbill Converter
  • DRG to ICD-10-CM
  • HCPCS to ICD-10-CM
  • ICD-10-CM to HCC
  • DRG to ICD-10-PCS
  • CPT® to ICD-10-PCS

Some of the crosswalks in Codify are developed and maintained by AAPC, while others come from trusted sources such as the Centers for Medicare & Medicaid Services (CMS). If your medical coding software does not give access to crosswalk data, AAPC’s crosswalks can be purchased (CMS crosswalks are free, but hard to locate because they are not all in one place).

Make the Most of Crosswalks

Using crosswalks has many advantages: For one, they are a huge timesaver. I cannot count how many times I have looked for an LCD, found it, and realized the policy had been superseded.

Another advantage is validation. When coding drugs, sometimes the lot number is used instead of the National Drug Code (NDC), which can result in denied claims. Using the NDC to CPT®/HCPCS crosswalk can help validate whether an NDC number can be billed with a CPT®/HCPCS Level II code. One of the best examples we can use here is the influenza vaccines, as they have various codes dependent upon if the virus is live or inactive, administration type, and other variations.

Crosswalks are an excellent tool for anyone in the medical coding and billing fields when used correctly. While they do not ensure payment, they are useful in quickly finding information on codes that are potentially covered and supported if documented. As always, though, you should consult individual payers to determine whether there is overriding policy for the services or supplies being billed.


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Kaitlyn Brack

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About Has 3 Posts

Kaitlyn Brack, BSHIIM, CPC, CEMC, CFPC, is a medical coding quality analyst for AAPC’s publishing department. Her coding strengths include Medicare wellness, evaluation and management, family practice, internal medicine, and pediatrics, with experience working in endocrinology, rheumatology, palliative care, rural health, and oncology. She has a Bachelor of Science in health informatics and information management from the University of Southern Indiana. Brack also has her yellow belt certification for Lean Six Sigma.

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