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To Use a G code or not tis the question

  1. #1
    Cool To Use a G code or not tis the question
    Medical Coding Books
    I have just always known certain G codes to use, but when and where is the regulation listed that says when we use them and not? Say for mammos, thinprep, and any of the G codes?

    Kimber Engel, CPC
    Gal Friday, Coder, Auditor, etc

  2. #2
    Location
    Covington, LA
    Posts
    89
    Default
    You have to check with your individual insurance carriers. Medicare uses them. Some insurances follow suit and some do not.

  3. #3
    Default
    But the issue is that Medicare doesn't even require all of them... I'm not asking about commercial. I'm asking where the guideline from CMS is about when to use them and when not with Medicare...

  4. #4
    Location
    Tacoma, WA
    Posts
    1,087
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    Quote Originally Posted by kengel1975 View Post
    But the issue is that Medicare doesn't even require all of them... I'm not asking about commercial. I'm asking where the guideline from CMS is about when to use them and when not with Medicare...
    Guidelines for using Medicare codes are found on the CMS website. They have a specific section for the preventive codes and the main billing manual has guidelines for all types of services. It takes some time to look through their website, but you would be amazed at the information you can find.

    Whichever company your Medicare billing goes thru also generally has all this information and they have websites as well; i.e. here in Washington State we bill Noridian for Medicare claims and their website has lots of helpful information.
    Arlene J. Smith, CPC, CPMA, CEMC, COBGC

  5. #5
    Default
    Thanks. I was actually hoping someone had that link or the info handy. CMS's website is horribly not user friendly and I spend much more time than I have researching as it. Also we do our own MCR charges, not everyone uses an outsourced company. Actually most don't.

    I will just look it up myself or delegate it to this person who asked. Seems that no one else truly knows either.....

  6. #6
    Default
    Quote Originally Posted by ajs View Post
    Guidelines for using Medicare codes are found on the CMS website. They have a specific section for the preventive codes and the main billing manual has guidelines for all types of services. It takes some time to look through their website, but you would be amazed at the information you can find.

    Whichever company your Medicare billing goes thru also generally has all this information and they have websites as well; i.e. here in Washington State we bill Noridian for Medicare claims and their website has lots of helpful information.
    You meant who are MAC is, not who a clearing house is. Was unclear on that but... still a lot of hoops to go through to get simple info

  7. #7
    Location
    Tacoma, WA
    Posts
    1,087
    Default
    Quote Originally Posted by kengel1975 View Post
    Thanks. I was actually hoping someone had that link or the info handy. CMS's website is horribly not user friendly and I spend much more time than I have researching as it. Also we do our own MCR charges, not everyone uses an outsourced company. Actually most don't.

    I will just look it up myself or delegate it to this person who asked. Seems that no one else truly knows either.....
    http://www.cms.gov/manuals/downloads/clm104c18.pdf
    http://www.cms.gov/manuals/Downloads/bp102c15.pdf

    There is a whole section also of free webinars you can get CEUs for on the website. I found them very helpful.
    Arlene J. Smith, CPC, CPMA, CEMC, COBGC


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