Need Coding Assistance
What resources are available for coding assistance?
Coding questions are best handled by coding professionals. The Medical Policy staff and Provider Outreach and Education staff at Wisconsin Physicians Service (WPS) Medicare are not professional coders. We do from time to time help providers with coding questions as they relate to Medicare Policy and/or claim denial(s); however, the Centers for Medicare & Medicaid Services (CMS) Internet-Only Manual (IOM) 100-9, Chapter 6, Section 30.1 explains that providers should seek professional guidance for their coding questions. All italicized information in the article is from the CMS IOM. To reference this publication, please refer to the CMS Website by clicking here. 
Here are examples of inquiries that require professional coding assistance:
1) Susie from the Sunshine Clinic calls Medicare regarding how to code a surgical service for Dr. Fall. Marge, a Customer Service Representative from WPS Medicare answers the telephone inquiry. Marge explains to Susie that she wishes she could help, but is unable to give coding advice, as she is not a professional coder.
2) Is it appropriate to report XXXXX to Medicare when only one of the descriptors is done?
3) Mary from Blue Sky Radiology calls Medicare regarding how to code an X-Ray read by radiologist Lucy Spring. Lucas, a Customer Service Representative from WPS Medicare answers the telephone inquiry. Lucas explains to Mary that he wishes he could help, but is unable to give coding advice, as he is not a professional coder.
4) What is the proper code to use when Computed Tomography (CT) scans are done for the evaluation of coronary arteries?
5) I need to know if we are able to charge for a (insert your description here). If so, is there a CPT code and do you pay for it.
These resources will help you too.
For ICD-9 diagnosis coding advice, use the following resource:
ICD-9-CM related questions are handled by the American Hospital Association's Coding Clinic.
Coding Advice/Central Office on ICD-9
American Hospital Association
One North Franklin
Chicago, IL 60606
Or e-mail Kayala@aha.org for information in Vols. 1 and 2
World Health Organization Collaborating Center for Classification of Diseases in North America
National Center for Health Statistics
Department of Health and Human Services
6525 Belcrest Road
Hyattsville, MD 20782
Morbidity Classification Branch
National Center for Health Statistics
Department of Health and Human Services
6525 Belcrest Road
Hyattsville, MD 20782
Centers for Medicare & Medicaid Services (CMS)
Division of Prospective Payment
Mail Stop C5-06-27
7500 Security Blvd.
Baltimore, MD 21244-1850
CMS Website
For CPT Procedure Coding advice, use the following resource:
Current Procedural Terminology (CPT-4) are codes proprietary to the American Medical Association (AMA). As such, CPT coding questions from providers (with expectations noted in 4 below) shall be referred to the AMA. The AMA offers CPT Information Services (CPT-IS). This new internet based service is a benefit to AMA members and is available as a subscriptions fee-based service for members and non-physician. The AMA also offers CPT Assistant. Information about these resources is found by clicking here.
E-mail the American Medical Association (AMA) here.
Call the CPT Information Services (CPTIS) at 1-800-634-6922
Visit the CMS Website General HCPCS Coding Questions section by
clicking here.
For HCPCS Procedural Coding Advice, use the following resources:
Level II Healthcare Common Procedure Coding System (HCPCS) codes related to Durable Medical Equipment or prosthetics, orthotics, and supplies are answered by the Statistical Analysis Durable Medical Equipment Regional Carrier (SADMERC) or, in the future, the Data and Analysis Coding function contractor (DAC). This contractor has a Web site with lots of information and a toll-free helpline.
The American Hospital Association's coding Clinic for HCPCS responds to questions related to CPT-4 codes for hospitals providers and Level II HCPCS codes, specifically A-codes for ambulance service and radiopharmaceuticals, C-codes, G-codes, J-codes, and Q-codes (except Q0136 through Q0181), for hospitals physicians and other health professionals who bill Medicare. Details about this resource are available by clicking here.
A state medical society may also be able to offer coding advice for a provider.
The resources provided above are from CMS publications, 2007 Current Procedural Terminology (CPT) book and the 2006 International Classification of Diseases 9th Revision.
Page Last Updated: Saturday, 03-Nov-2007 11:21:17 CDT
