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Thread: Coding CPT with out associated ICD-9

  1. #1
    Join Date
    Apr 2007

    Default Coding CPT with out associated ICD-9

    AAPC: Back to School
    Does anyone know where I can find written documentation that states that in order to assign a CPT to a patient you must have an ICD9 to go w/the procedure? I have a provider that wants to see it in black and white.

  2. #2
    Join Date
    Apr 2007
    Hartford, CT


    Look up the Evaluation and Mangement Serives Guide on the CMS website. This is basically a synopsis of Their documentation guidelines. Specifically pages 10 and 23. This is the link http://www.cms.gov/MLNProducts/downl...-ICN006764.pdf

    Hopefully this will abe a place for you to start.

  3. #3
    Join Date
    Apr 2007
    Chesapeake, VA

    Default celeste

    Try the Medicare Claims Processing Manual, excerpts follow:

    Medicare Claims Processing Manual
    Chapter 26 - Completing and Processing
    Form CMS-1500 Data Set
    (Rev. 2162, 02-22-11)

    10.4 - Items 14-33 - Provider of Service or Supplier Information

    Item 21 - Enter the patient's diagnosis/condition. With the exception of claims submitted by ambulance suppliers (specialty type 59), all physician and nonphysician specialties (i.e., PA, NP, CNS, CRNA) use an ICD-9-CM code number and code to the highest level of specificity for the date of service. Enter up to four diagnoses in priority order. All narrative diagnoses for nonphysician specialties shall be submitted on an attachment

    10.1 – Claims That are Incomplete or Contain Invalid Information
    (Rev. 145, 04-23-04)
    If a claim is submitted with incomplete or invalid information, it may be returned to the submitter as unprocessable. See Chapter 1 for definitions and instructions concerning the handling of incomplete or invalid claims.

    10 - Health Insurance Claim Form CMS-1500 (Rev. 2162, Issued: 02-22-11, Effective: 03-21-11, Implementation: 03-21-11)
    The current version of the form is Form CMS-1500 (08/05) and is approved under the OMB collection 0938-0999. The Form CMS-1500 (Health Insurance Claim Form) is sometimes referred to as the AMA (American Medical Association) form. The Form CMS-1500 is the prescribed form for claims prepared and submitted by physicians or suppliers, whether or not the claims are assigned.

    The Form CMS-1500 answers the needs of many health insurers. It is the basic form prescribed by CMS for the Medicare and Medicaid programs for claims from physicians and suppliers. It has also been adopted by the TRICARE Program and has received the approval of the American Medical Association (AMA) Council on Medical Services.
    (End Quote)
    Hope this helps.

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