Guidelines and Manuals

Below is a list of categories with applicable links and resources for your convenience.

CPT Coding

AMA's E&M Guidelines

Evaluation and Management (E/M) Services Guidelines

AMA's CPT Section Guidelines

Search AMA's CPT Guidelines by Section

E&M Code Guidelines & Instructions

E&M Code Guidelines and Evaluation & Management Code Instructions

1995 E&M Documentation Guidelines

1995 Documentation Guidelines for Evaluation & Management Services

1997 E&M Documentation Guidelines

1997 Documentation Guidelines for Evaluation and Management Services

Diagnostic Coding

ICD-10-CM Guidelines

The Official ICD-10-CM Guidelines for Coding and Reporting

ICD-10-CM Quick Reference

MLN's ICD-10-CM Classification Enhancements

ICD-9-CM Guidelines

The Official ICD-9-CM Guidelines for Coding and Reporting

Hospital/Facility Coding

ICD-10-PCS Official Guidelines

The Official ICD-10-PCS Guidelines for Coding and Reporting

ICD-10-PCS Reference Manual and Files

ICD-10-PCS Reference Manual

ICD-9 Vol. 3 Coding Information

ICD-9 vol 3 Procedure Code Information

APC Coding

APC Codes (Ambulatory Payment Classifications)

Forms

InstaGuide to the CMS 1500

InstaGuide to the CMS 1500 Health Insurance Claim Form

Medicare CMS 1500 Instructions

Medicare CMS1500 02/12 Claim Form Instructions

Revised CMS-1500 Form Overview

The Revised CMS-1500 Form … at a Glance

Dental ADA Claim Form

ADA Claim Form 2006 - Paper

ADA Claim Form Instructions

ADA Claim Form 2006 - Electronic Instructions

Medicare

Provider Compliance Newsletter

Medicare Quarterly Provider Compliance Newsletter

Factsheets

Medicare Factsheets

PUB 100: Internet Only Manuals (IOMs)

CMS: Internet Only Manuals

PUB 100-01

General Information Manual

PUB 100-02

Benefit Policy Manual

PUB 100-03

National Coverage Determinations

PUB 100-04

Claims Processing Manual

PUB 100-05

Secondary Payer Manual

MIPS

Merit-based Incentive Payment System (MIPS)

MIPS Manual

Medicare Quality Reporting Incentive Programs Manual

CLIA

Clinical Laboratory Improvement Amendments (CLIA)

E&M Guides & Manuals

Medicare Evaluation & Management (E&M) Guides and Manuals

LCDs/Articles

Search LCDs, Articles, and NDCs by Medicare Contractors

Forms

Medicare Forms

NCCI Edits Policy Manual

NCCI Policy Manual Archive

Paper-Based Manuals

Medicare Paper-Based Manuals

FAQs

Medicare FAQs

Hospital Outpatient Regulations and Notices

Hospital Outpatient Regulations and Notices

NCDs

National Coverage Determinations

CMS-1500 Claim Form Tutorial

CMS-1500 Claim Form Tutorial

Miscellaneous

Federal Register

Federal Register Document Search

OIG Physician Compliance

OIG Compliance Program for Individual and Small Group Physician Practices

PubMed

Over 29 million citations for biomedical literature from MEDLINE, life science journals, and online books

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

Changes to Portable X-Ray Requirements

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On September 30, 2019, CMS published a final rule which made changes to portable x-ray services requirements as found in the law.

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The New ICD-10-CM Code Updates Are Here — Are You Ready?

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Chapter 1: Certain Infectious and Parasitic Diseases (A00-B99) A small revision in the description changed[STEC] to (STEC) for B96.21, B96.22, B96.23. Remember, in the instructional guidelines, ( ) parentheses enclose supplementary words not included in the description (or not) and [ ] brackets enclose synonyms, alternative wording, or explanatory phrases. Chapter 2: ...

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Let's Talk High Risk E/M Services

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Have you ever assigned a high-complexity E/M code (e.g., 99205, 99215, 99223, 99233, 99245, etc.) and wondered if it would stand up to further scrutiny? Well, let’s take a closer look at the requirements for reporting high-level E/M services.   Both the American Medical Association and Medicare-published E/M Guidelines agree that a ...

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What is Medical Necessity and How Does Documentation Support It?

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We recently fielded the question, “What is medical necessity and how do I know if it's been met?" The AMA defines medical necessity as: It is important to understand that while the AMA provides general guidance on what they consider medically necessary services, these particular coding guidelines are generic and may be ...

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The Impact of Medical Necessity on High Level E/M Services

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I was recently asked the question, "Does 99233 require documentation of a past medical, family, and/or social history (PFSH)?"  The quick answer is, "it depends." Code 99233 has the following minimal component requirement: Subsequent inpatient E/M encounters can meet the code level requirement either by component scoring & medical necessity or time & medical necessity. ...

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Understanding NCCI Edits

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Medicare creates and maintains the National Correct Coding Initiative (NCCI) edits and NCCI Policy Manual, which identify code pair edits. When performed on the same patient, on the same day, and by the same provider, the secondary code is considered an integral part of the primary code, and payment for ...

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Proposed Rule: Expanded Telemedicine Benefits for Medicare Advantage Beneficiaries

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Telemedicine continues its rise, with new technologies allowing for better communication and access to more aspects of healthcare than ever before. Each year Medicare has made strides, albeit small strides, in their telemedicine coverage while commercial payers continue to make great strides, constantly improving and expanding telemedicine service offerings to ...

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Truncated ICD-10-CM Official Guidelines for Coding and Reporting

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Adherence to ICD-10-CM official guideline's are required under HIPAA and adopted for all healthcare settings. We have made it easy to access guidelines and made them available on the code information page, either on the page you are viewing or view more information by selecting the ICD-10-CM Chapter Section/Guidelines and ...

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WHO Said ICD-11 is Coming Soon

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Sooner or later ICD-11 will be released, and it sounds like it will be sooner than later. WHO released the news on June 18, 2018. The World Health Organization stated “ICD-11 will be presented at the World Health Assembly in May 2019 for adoption by Member States, and will come ...

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Access to this feature is available in the following products:
  • HCC Coder
  • Find-A-Code Professional
  • Find-A-Code Facility Base


Select the webinar title to view a summary and link to the webinar video.

Finally, the SOAP Note That Will Satisfy Everyone

Every regulator, every payer, and every chiropractor will tell you that they have the perfect SOAP note. But then why are they all different? In this raucous presentation Dr. Gwilliam, Clinical Director for PayDC EHR software, will finally bring all these parties together. We'll look at the requirements and elements that make up a good note and then break it down so that you can build one without suffering from a breakdown.

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Injection Coding Changes for 2020

Injection Coding Changes for 2020

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Proving Medical Necessity and Functional Improvement

Medicare is required by law to pay for care that is medically necessary. Medicare considers functional improvement to be the primary indicator of medical necessity for chiropractic care. It is up to you, the doctor, to prove functional improvement and medical necessity with your documentation. Dr. Short will show you how to use common practice tools to document functional improvement, medical necessity and maximum medical improvement.

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Inappropriate Payments Made to Chiropractors – An OIG Review

In this webinar, Dr. Gwilliam will take you on a fun filled journey through all of the reports created by the Office of the Inspector General based on their reviews of chiropractors. If you can understand what they see, and what advice they give Medicare when dealing with chiropractors, then you will be better prepared to not become their next target. This webinar may feel a little frightening with hundreds of thousands of dollars paid back to CMS, but, by the end, you will know exactly what to do and what not to do.

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Expanding Chiropractic Coverage in Medicare

Currently Medicare only pays for the adjustment and then only when it is used to correct a subluxation. This injustice within the Social Security Act needs corrected. Dr. Ron Short will discuss the Medicare laws as they relate to chiropractic and what changes need to be made and why. ...

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Confusing Codes for Chiropractors - 97110 versus 97112 versus 97530

In this webinar, you'll get a deep dive into three therapeutic procedure codes. Dr. Gwilliam, a chiropractor and certified professional coder, will take you thorough the ins and outs of therapeutic exercises, activities, and neuromuscular reeducation. They will be compared and contrasted with examples to make sure everyone leaves with the confidence to document and bill them correctly.

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Evaluation and Management Coding

The Evaluation and Management service is an important part of an episode of care. It is the initiation of care and determines the scope and severity of the patient’s condition. Dr. Ron Short will review the levels of Evaluation and Management codes and which are appropriate in the chiropractor’s office. In this webinar you will learn: What constitutes a new patient Which Evaluation and Management codes should not be used When to use the consultation code What changes are coming to Evaluation and Management coding

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Chiropractic Manipulative Treatment and Medicare - Part 2

In this CE webinar, Dr. Gwilliam will continue his discussion from the webinar delivered Dec. 18 about chiropractic manipulative treatment. But this time, it is all about Medicare. If you don't treat Medicare beneficiaries, you should probably listen anyway. Usually whatever Medicare wants is the same thing as all the other payers. Find out the difference between acute, chronic, and maintenance, as well as when to use certain modifiers.

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Reimbursement Guides
2020 Edition

Find-A-Code's 2020 specialty specific Reimbursement Guides give you the coding, billing, and documentation support you need to get paid properly and keep it.

  • Medicare
  • Procedure & Supply codes
  • Documentation
  • Compliance
  • HCC information
  • ICD-10-CM codes



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