AMA CPT® Assistant - 1998 Issue 3 (March)
HCFA to Fix Coding Initiative Edits (March 1998)
March 1998 page 3 HCFA to Fix Coding Initiative Edits HCFA to Fix Coding Initiative Edits A significant number of Medicare claims are being erroneously denied due to a glitch in new editing tools that the Health Care Finance Administration (HCFA) uses to check claims for accuracy. Certain CPT Codes in the laboratory section, when reported in conjunction with any Evaluation and Management Service code ( 99201 - 99360 ), have been incorrectly bundled in the edit system. HCFA has indicated that the edits result in automatic denials for the following tests, when reported on the same date of...
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Article Overview
This article explains a Medicare claims editing issue identified by HCFA in 1998 and describes the types of laboratory and evaluation-and-management billing relationships involved, along with the fact that the edits were part of the Correct Coding Initiative. It is relevant for billing staff, coders, and compliance professionals who need to understand historical CPT editing changes and the administrative response to erroneous denials.
Why This Topic Matters
It helps readers recognize a specific claims-editing problem that affected lab reporting under Medicare and understand the operational impact on denied claims and pending corrections.
Article Sections
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March 1998 page 3
A short news item on Medicare claim editing issues, the administrative response from HCFA, and the broader context of claims processing corrections.
What You Will Learn
- The general nature of the Medicare claims editing issue described in the notice
- Which broad types of services were affected by the editing problem
- What administrative response was being taken to address the issue
- How the article situates the issue within the Correct Coding Initiative
Who Should Read This
- Medical coders
- Billing staff
- Compliance professionals
- Revenue cycle teams
- Physician office staff
Codes Discussed
Code Ranges Discussed
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