What Medical Necessity Tools Does Find-A-Code Offer?

June 13th, 2019 - Aimee Wilcox, CPMA, CCS-P, CST, MA, MT, Director of Content
Categories:   Audits/Auditing   Billing   Claims   Compliance   Denials & Denial Management   Documentation Guidelines   Evaluation & Management (E/M)  
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Find-A-Code is a great resource for individuals working in all aspects of healthcare, from providers and ancillary staff to the attorneys and payers who assess and critique the documentation supporting the services performed. When recently asked what tools Find-A-Code has to help support medical necessity, our response was, "We provide many resources on medical necessity."

Some of the Find-A-Code resources that help identify medical necessity include: 

  • Medicare-specific resources:
    • National Coverage Determinations (NCDs) and Local Coverage Determinations (LCDs) identify medical necessity in the Coverage Guidance section and ICD-10-CM codes which support a particular CPT or HCPCS code are found in the Coding Information section. 
    • Medicare Pub100 publications in the Info tab at the top of the screen facilitate access to Medicare policies and guidelines where medical necessity is often further defined.
    • Medicare's 1995 and 1997 Evaluation and Management Guidelines, including the Table of Risk, helps identify the severity of an illness, condition, injury, or symptom that may support the work required at a specific level of service. 
  • Commercial payer resources:
    • Our Commercial Payer Policies add-on tool is a great resource for quickly accessing specific payer policies pertaining the ICD-10-CM, CPT, or HCPCS code. Quickly identify if a policy is in place for the service you are reviewing, along with any identifiably linked ICD-10-CM codes or documentation requirements.
  • Find-A-Code also provides access to specific code-set resources:
    • American Medical Association's (AMA) CPT code set and complete guidelines. These include general and chapter-specific guidelines, including those associated with identifying the proper level of E/M service based on Nature of Presenting Problems (NPP). The NPP explanations are very helpful when trying to decide if the level of service is warranted. 
    • Common Language Descriptions (CLDs) for ICD-10-CM codes assist in defining the diagnosis and understanding the terminology in layman's terms. Additionally, access to both the General and Chapter-specific ICD-10-CM Coding Guidelines identify coding conventions for sequencing and multiple code reporting to ensure accuracy and support medical necessity.
    • Current Dental Terminology (CDT) facilitates access to dental-specific codes and their guidelines. 
  • Newsletters and Articles that provide additional understanding of appropriate code reporting and medical necessity at the individual code level or in general:
    • CPT Assistant
    • Decision Health
    • American Hospital Association
    • Just Coding Newsletter
    • BC Advantage
    • Find-A-Code subject matter expert articles listed on the Topics page or at the bottom of the home page under "Articles."

As you can see, Find-A-Code is a comprehensive online tool that links vital resources directly to each code in any of the code sets, often removing the need for bookmarks or browser history searches. Find-A-Code saves your last 10 codes, searches, and pages visited so you can quickly find them in one location and you can even save specific codes and customized notes specific to them within the "My Codes" tool that can then be easily shared among others within your organization and subscription group. 

If you've been searching for that "all-in-one" online resource but haven't had an opportunity to play around in Find-A-Code, register today for the 28-day Free Trial (no credit card required) and get a feel for how this time-(and revenue) saving product can increase productivity and reduce stress.

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