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.

MEGA - NCCI Edit Changes - WHO Knew?

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There was no huge announcement when CMS released new files in April. The files that were released on April 7, 2020, actually replaced files to update the NCCI edits on Procedure to Procedure (PTP) edits and Medically Unlikely Edits (MUE).  The updated files included; 291,902 Deleted Procedure to Procedure (PTP) edits 197  Deleted Medically Unlikely ...

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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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