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Bookmark these for future reference when you need help coding.
Best advice I was given was make Google your new BFF.
But BEWARE know your source & always check dates as coding changes frequently & a good coder needs to stay current in their knowledge to stay relevant in the field.
Medicare offers an online Claims Processing Manual, which provides day-to-day operating instructions, policies, and procedures based on statutes and regulations, guidelines, and directives.
The CMS website is filled with educational information such as the guidelines for teaching hospitals, definitions (co-surgeon, assistant surgeon, etc.), internet-only manuals (IOMs), future updates to the IOM, paper-based manuals, transmittals, and quarterly provider updates.
Of the 38 chapters that comprise the IOM, chapters that provide general coding guidelines to the medical coder and to other healthcare providers are:
Chapter 1 – General Billing Requirements
Chapter 10 – Reporting ICD Diagnosis and Procedure Codes
10.1 – General Rules for Diagnosis Codes
10.2 – Inpatient Claim Diagnosis Reporting
10.3 – Outpatient Claim Diagnosis Reporting
10.4 – ICD Procedure Code
10.5 – Coding for Outpatient Services and Physician Offices
10.6 – Relationship of Diagnosis Codes and Date of Service
Chapter 12 – Physicians/Non-physician Practitioners
Chapter 14 – Ambulatory Surgical Centers
Chapter 20 – Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS)
Chapter 23 – Fee Schedule Administration and Coding Requirements
These chapters may be downloaded and saved on your computer or other electronic device as PDF files.
Free resources that will help you report provider services accurately. Due to productivity demands, medical coders may be tempted to rely on word of mouthTake time to look up the information will increase subject matter knowledge, build essential fact-finding skills, and improve coding accuracy.
Ensuring the Affordable Care Act Serves the American People The Center for Consumer Information and Insurance Oversight (CCIIO) is charged with helping implement many reforms of the Affordable Care Act, the historic health reform bill that was signed into law March 23, 2010. CCIIO oversees the...
The AMA's Current Procedural Terminology (CPT®) code set is essential for billing outpatient and office procedures, enhances accuracy and efficiency in reporting, claims processing, and developing medical care guidelines. The AMA strives to improve health care by refining CPT codes and processes.
www.ama-assn.org
The AMA provides CPT® coding guidelines that detail when and how to assign codes, how providers perform procedures, which codes can and can’t be reported together, and other factors critical to compliant coding.
It can’t be emphasized enough to review the CPT® guidelines laid out in each section, subsection, subheading, category, and subcategory—before attempting to assign codes within that classification.
Equally important, before assuming a position with the responsibility of determining and reporting CPT® codes on medical claims, consider seeking proper training and credentialing. This is the best way to ensure coding accuracy and optimal reimbursement for your employer.
CMS publishes the NCCI coding policies, which are updated annually. NCCI is based on AMA’s coding conventions, national and local policies and edits, coding guidelines developed by national societies, analysis of standard medical and surgical practices, and a review of current coding practices. The NCCI promotes national correct coding methodologies and is used to control improper coding.
The Policy Manual for Medicare Services is a general reference tool that explains the rationale for NCCI edits. If you do not read the NCCI guidelines in its entirety, at least read both the Introduction and Chapter 1, General Correct Coding Policies.
NCCI includes three types of edits:
(1) NCCI PTP Coding Edits;
(2) Medically Unlikely Edits (MUE); and
(3) Add-on Code Edits. Tip: The NCCI policies may differ from the CPT® code book. When coding a Medicaid or Medicare patient’s case, coding should follow NCCI guidelines.
The General Correct Coding Policies for NCCI Policy Manual states:
The American Medical Association publishes CPT Assistant which contains coding guidelines. CMS does not review nor approve the information in this publication. In the development of NCCI PTP edits, CMS occasionally disagrees with the information in this publication. If a physician utilizes information from CPT Assistant to report services rendered to Medicare patients, it is possible that Medicare Carriers (A/B MACs processing practitioner service claims) and Fiscal Intermediaries may utilize different criteria to process claims.
PTP Coding Edits
The PTP edits are CPT® code pairs that should not be coded together. NCCI PTP edits prevent improper payment when incorrect code combinations are reported. Reasons for why specific code pairs should not be coded together are explained in the Policy Manual for Medicare Services.
NCCI PTP edits are used by Medicare claims processing contractors to adjudicate provider claims for physician services, outpatient hospital services, and outpatient therapy services. They are not applied to facility claims for inpatient services.
MUEs
The NCCI MUE program prevents payment for an inappropriate quantity of the same service on a single day. An MUE is the maximum number of units of service under most circumstances reportable by the same provider for the same patient on the same date of service. An Excel spreadsheet of most procedure code MUEs is located at the CMS website. Not all procedure codes are included.
Add-on code edits consist of a listing of HCPCS Level II and CPT® add-on codes with their respective primary codes. An add-on code is eligible for payment only if one of its primary codes is also eligible for payment
Medicare Learning Network®: Global Surgery Booklet provides education on the global surgery package. Uniform payment policies and claims processing requirements have been established for surgical issues. The Global Surgery MLP provides guidance on:
Evaluation and management (E/M) services (same day decision for surgery, significant, separately identifiable E/M services by the same physician on the same day of the procedure)
Global surgery coding and billing guidelines
Pre-operative period billing
Day of procedure billing
Claims for multiple surgeries
Claims for co-surgery
Claims for assistant at surgery services
Post-operative period billing
Return to the operating room (OR) for a related procedure during post-operative period
Staged or related procedure or service by the same physician during the post-operative period
Critical care
Billing for bilateral procedures
Global surgery indicators: 000, 010, 090, XXX, YYY, ZZZ
For more information, refer to the Medicare Claims Processing Manual, Chapter 12, Sections 40 and 40.1.
HHS-OIG is the largest inspector general's office in the Federal Government, with more than 1,600 employees dedicated to government oversight, combating fraud, waste and abuse and to improving the efficiency of HHS programs. A majority of the OIG's resources goes toward the oversight of Medicare...
oig.hhs.gov
Annual Work Plan
Exclusions Lookup
Compliance Guidance
Corporate Integrity Agreements
RAT_STATS
Navigating the Office of the Inspector General website - Did You Know CCO
Compliance Program Guidance for Third-Party Medical Billing Companies
The MPFS is a list of CPT®/HCPCS Level II services and procedures. The MPFS provides information on each procedure code, such as the global surgery indicator, multiple surgery indicator, co-surgery/assistant surgery indicator, bilateral procedures, relative value units (RVUs), etc.
CMS has recalculated the MPFS payment rates and conversion factor to reflect ... payment for teaching physicians, and provides clarification on medical record ... This proposed rule proposes potentially misvalued codes and other policies
Physician Fee Schedule: CY 2026 Proposed Rule – Submit Comments by September 12CMS issued the CY 2026 Physician Fee Schedule (PFS) proposed rule that announces and solicits public comments on proposed policy changes for Medicare payments under the PFS and other Medicare Part B issues.
AMBA hosts several free webinars throughout the year aimed at providing free CEU credit through AMBA, AAPC and PMI. » Register for our next webinar Learn more about our Certified Medical Reimbursement…
Easily access your account with a login to My ACG. Manage your profile, explore exclusive member gastroenterology resources and news, and stay connected.
ASGE is your voice, partner, and resource in a rapidly evolving healthcare environment. Find management solutions, programs, compliance resources and more with ASGE.
www.asge.org
ASRM
These resources from the ASRM Coding Committee provide guidance on coding for reproductive health.
There has been confusion regarding the appropriate use of Current Procedural Terminology (CPT ® American Medical Association) codes related to the evaluation of auditory rehabilitation status. The guidance below is based on an article, "Coding Brief: Evaluation of Auditory Rehabilitation Status...
Feel secure about your coding proficiency and keep up-to-date on Medicare policies with our electronic coding publication for diagnostic and interventional radiology, radiation oncology, nuclear medicine and medical physics coding and reimbursement news.
Orthopaedic surgeons and healthcare providers will find the resources needed to code correctly and bill appropriately for orthopaedic services. The AAOS is your source for orthopaedic coding and reimbursement information.
Access the Coding Resource Center to find Academy coding tools and resources. Find information on E/M codes, ICD-10 codes, modifiers, audits, coding guides, and more.
www.aad.org
ACOG American College of Obstetrics & Gynecologists:
Access the Coding Resource Center to find Academy coding tools and resources. Find information on E/M codes, ICD-10 codes, modifiers, audits, coding guides, and more.
A tutorial from MedlinePlus on understanding medical words. You'll learn about how to put together parts of medical words. You'll also find quizzes to see what you've learned.
Medical Dictionary is intended for use by healthcare consumers, students, and professionals as well as anyone who wants to keep up with the burgeoning array of terminology found in today’s medical news. By staying clear of jargon, the dictionary offers fast and concise information, whether the...
GlobalRPh Introduction to Medical Terminology Article written by: Barron Hirsch, MBA For the health care professional, it is imperative that precision is used in the way patients’ physical conditions and diseases are described. Modern medical terms and terminology provides such precision and...
Get Body Smart:
A free website study guide review that uses interactive animations to help you learn.
An Online Examination of Human Anatomy and Physiology
Animated Text Narrations and Quizzes to Explain the Structures and Functions of the Human Body Systems.
An Online Examination of Human Anatomy and Physiology
A free website study guide review that uses interactive animations to help you learn online about anatomy and physiology, human anatomy, and the human body systems. Start Learning now!
The Novitas Solutions website is an administrative services processing company for Medicare providers and healthcare industry professionals to use. Novitas administers the Medicare Administrative Contractor (MAC) Jurisdiction L (JL), and Jurisdiction H (JH) for Part A, hospitals and other facilities, and Part B, physicians and other healthcare professionals.
Some resources the Novitas Solutions website offers are:
An E/M interactive score sheet. The system helps with coding E/M cases.
A list of modifiers, including HCPCS Level II, the Advance Beneficiary Notice, end-stage renal disease, anesthesia, anatomical, etc.
Check your MAC’s website for similar offerings relative to your jurisdiction.
AAPC offers a plethora of free tools to make medical coding and billing easy. Use these tools to improve your medical documentation speed with precision.
Our Free E&M Audit Tools will help you code in various settings such as office, hospital, facility or home. Download it today!
www.cco.us
There are many things you need to consider in order to determine the appropriate E&M code to use. But, it does not need to be as complicated as you may think. Our step-by-step guide will show you the exact steps that you need to take to ensure accurate coding.
This guide will take you through the following questions for each case you try to code:
What is the E/M category/subcategory (location and service type)?
What is the level of history?
What is the exam level?
What is the level of medical decision-making?
Is time a dominant factor?
Once you have answered all of the above, you can then determine the final E&M level.
Our easy to use, our E&M Audit Tools will provide you with all you need to know about E&M coding in various settings such as offices, hospitals, facility or homes. It breaks down abbreviations such as CC (chief complaint); ROS (review of systems); and HPI (history of present illness) so you have a more comprehensive understanding of how these E&M codes work and what they mean.
Also included is an audit tool to help you score your E&M notes using this guide.
Appendix M - Procedures Requiring Prior Authorization (4/19) Review the Health First Colorado fee schedule to see if a PAR is required for the procedure code.
CGS provides a variety of services for Medicare beneficiaries, healthcare providers, and medical equipment suppliers in 38 states, supporting the needs of over 24 million Medicare beneficiaries and 100,000 healthcare professionals nationwide.
CGS provides a variety of services for Medicare beneficiaries, healthcare providers, and medical equipment suppliers in 38 states, supporting the needs of over 24 million Medicare beneficiaries and 100,000 healthcare professionals nationwide.
