Guidelines and Manuals
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Below is a list of categories with applicable links and resources for your convenience. CPT CodingAMA's E&M GuidelinesEvaluation and Management (E/M) Services Guidelines AMA's CPT Section GuidelinesSearch AMA's CPT Guidelines by Section E&M Code Guidelines & InstructionsE&M Code Guidelines and Evaluation & Management Code Instructions 1995 E&M Documentation Guidelines1995 Documentation Guidelines for Evaluation & Management Services 1997 E&M Documentation Guidelines1997 Documentation Guidelines for Evaluation and Management Services Diagnostic CodingICD-10-CM GuidelinesThe Official ICD-10-CM Guidelines for Coding and Reporting ICD-10-CM Quick ReferenceMLN's ICD-10-CM Classification Enhancements ICD-9-CM GuidelinesThe Official ICD-9-CM Guidelines for Coding and Reporting Hospital/Facility CodingICD-10-PCS Official GuidelinesThe Official ICD-10-PCS Guidelines for Coding and Reporting ICD-10-PCS Reference Manual and FilesICD-10-PCS Reference Manual ICD-9 Vol. 3 Coding InformationICD-9 vol 3 Procedure Code Information APC CodingAPC Codes (Ambulatory Payment Classifications) FormsInstaGuide to the CMS 1500InstaGuide to the CMS 1500 Health Insurance Claim Form Medicare CMS 1500 InstructionsMedicare CMS1500 02/12 Claim Form Instructions Revised CMS-1500 Form OverviewThe Revised CMS-1500 Form … at a Glance Dental ADA Claim FormADA Claim Form 2006 - Paper ADA Claim Form InstructionsADA Claim Form 2006 - Electronic Instructions MedicareProvider Compliance NewsletterMedicare Quarterly Provider Compliance Newsletter FactsheetsMedicare Factsheets PUB 100: Internet Only Manuals (IOMs)CMS: Internet Only Manuals PUB 100-01General Information Manual PUB 100-02Benefit Policy Manual PUB 100-03National Coverage Determinations PUB 100-04Claims Processing Manual PUB 100-05Secondary Payer Manual MIPSMerit-based Incentive Payment System (MIPS) MIPS ManualMedicare Quality Reporting Incentive Programs Manual CLIAClinical Laboratory Improvement Amendments (CLIA) E&M Guides & ManualsMedicare Evaluation & Management (E&M) Guides and Manuals LCDs/ArticlesSearch LCDs, Articles, and NDCs by Medicare Contractors FormsMedicare Forms NCCI Edits Policy ManualNCCI Policy Manual Archive Paper-Based ManualsMedicare Paper-Based Manuals FAQsMedicare FAQs Hospital Outpatient Regulations and NoticesHospital Outpatient Regulations and Notices NCDsNational Coverage Determinations CMS-1500 Claim Form TutorialCMS-1500 Claim Form Tutorial MiscellaneousFederal RegisterFederal Register Document Search OIG Physician ComplianceOIG Compliance Program for Individual and Small Group Physician Practices PubMedOver 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. June 10th, 2020 MEGA - NCCI Edit Changes - WHO Knew?| Published June 10th, 2020 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 ... November 19th, 2019 Changes to Portable X-Ray Requirements| Published November 19th, 2019 On September 30, 2019, CMS published a final rule which made changes to portable x-ray services requirements as found in the law. April 23rd, 2019 Let's Talk High Risk E/M Services| Published April 23rd, 2019 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 ... April 23rd, 2019 What is Medical Necessity and How Does Documentation Support It?| Published April 23rd, 2019 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 ... March 21st, 2019 The Impact of Medical Necessity on High Level E/M Services| Published March 21st, 2019 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. ... March 1st, 2019 Understanding NCCI Edits| Published March 1st, 2019 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 ... February 14th, 2019 Proposed Rule: Expanded Telemedicine Benefits for Medicare Advantage Beneficiaries| Published February 14th, 2019 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 ... January 22nd, 2019 Truncated ICD-10-CM Official Guidelines for Coding and Reporting| Published January 22nd, 2019 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 ... (There are no webinars at this time, please check back later.)
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