Claims Articles and Resources

News and Important Information

What Medical Necessity Tools Does Find-A-Code Offer?

Keys to Successful Claims Filing

See also Chapter 1 - Insurance & Reimbursement in Find-A-Code's specialty specific Reimbursement Guides or the ChiroCode DeskBook for important claims processing information.

Additional Links and Resources

Billing Requirements for OPPS

Billing Requirements for OPPS Providers with Multiple Service Locations

Select the title to see a summary and a link to the full article.

Is Your Organization Ready to Deal with Provider Relief Fund (PRF) Audit Contractors?

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Audits are currently underway to verify the monies distributed through the CARES Act were warranted and properly used by those organizations that received them. The federal government has contracted with financial institutions such as KPMG and PricewaterhouseCoopers, among others, to perform these audits referred to as Provider Relief Fund (PRF) audit contractors, funded with monies from the very same program. There were four phases of funding disbursements with phase 1 audits beginning in September. How ready are you to be audited?

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Injection Services

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Injection Service Codes Injection service codes, are reported under administration of vaccines/toxoids, using 96372, 90460, 90461, 90471, 90472, 0001A, 0002A, 0003A, 0011A, 0012A, 0021A, 0022A, 0031A, 0041A, and 0042A. Other injections services include: Non-antineoplastic hormonal therapy injections – 96372 Anti-neoplastic nonhormonal injection therapy 96401 Anti-neoplastic hormonal injection therapy- 96402 Allergen immunotherapy - 95115-95117 According to CMS, do ...

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Understanding How Place of Service Codes Work

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The Place of service (POS) codes are used by CMS, Medicaid, and other private insurance to indicate where medically related items and services are sold or dispensed for a patient. POS codes are used for professional billing and are required to be reported on each claim submitted on a CMS-1500 ...

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Compliance in the Dental Office or Small Practice

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If your practice does not already have a compliance program in place, you will want to get started after reading this article. We have uncovered some important findings with the Office of Inspector General (OIG) in dental practices you need to be aware of. A compliance program offers standard procedures to follow, ...

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Since When did Dental Claims Require Diagnosis Codes?

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The objective of the Accountable Care organization is to integrate and consolidate patient care management to improve patient outcomes. Changes and coordination of dental and medical care are already becoming more apparent when dental offices are being required to bill a patient's medical plan for dental visits due to an ...

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UB-04 Claim Form

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The UB-04 Claim Form, also known as CMS-1450, is used for submitting claims for reimbursement for specially designated facilities. The 837i is the electronic version of the form. Much like the 1500 Claim Form, maintained by the National Uniform Claim Committee, the UB-04 Claim Form is maintained by the National Uniform Billing Committee (NUBC) which maintains lists of approved codes used on various fields on the form (e.g., revenue codes, condition codes). Third-party payers, including Medicare, may have their own adaptations of the general instructions published by the NUBC.

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Q/A: Why is My Claim Being Denied When I Report a Secondary Diagnosis Code?

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Question: Recently my claims to Medicare are being denied when I submit a secondary diagnosis code. I’ve heard that this is happening in several states including Washington, California, and New York. Has there been a recent change in what secondary diagnosis codes are allowed?

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How to Search Find-A-Code for Medicare Policies and Guidelines — LCDs, NCDs and Articles —

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Help for Searching Find-A-Code when searching for Medicare Policies and Guidelines — LCDs, NCDs and/or Articles.

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Cross-A-Code Instructions in Find-A-Code

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Cross-A-Code is a tool found in Find-A-Code which helps you to locate codes in other code sets that help you when submitting a claim.

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Coding with PCS When There is No Code

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ICD-10-PCS covers ALMOST everything! But not quite! What if a body system does not contain a body part for toes or fingers? What about an elbow? When it does not cover what you are looking for, where do you turn?  To the guidelines, of course! There are ICD-10-PCS guidelines just as ...

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Understanding UCR Inpatient Fees used on DRGs

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"What is the ICD-10 code for...?" - Search Smarter With Find-A-Code Tools

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Do you still find yourself searching the internet for an ICD10 code? Medical coders often type into their search engine, what is the ICD10 code for ... and a specific diagnosis code, to avoid repeatedly dragging out the incredibly large ICD10 codebook. Ironically, some of the most commonly searched ICD10 diagnoses include: ...

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Understand the New Codes for Testing & Reporting the COVID-19 Coronavirus (SARS-CoV-2)

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The current coronavirus pandemic refers to COVID-19, a novel or new type of coronavirus known as severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2). The first victim of the virus was identified in Wuhan, Hubei, China at the end of 2019. There is no immunization available to prevent it from spreading and ...

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Q/A: Did Noridian Stop Covering the M99.0- Codes?

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Question: I heard that Medicare Noridian Jurisdiction F (Alaska) has been denying claims with M99.00, M99.01, M99.02, M99.03 etc codes when billed with the CMT CPT codes. Did Medicare change their policy?

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Who Knew? There are Three Types of Add-On Codes

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Using add-on codes with HCPCS/CPT is not as simple as 123! Although there are three different groups of add-on codes assigned by CMS, these are used to identify code edits. It is easy to see the add-on code with some codes; we can see the instructional notes and phrases such ...

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