What Medical Necessity Tools Does Find-A-Code Offer?
June 13th, 2019 - Aimee Wilcox, CPMA, CCS-P, CST, MA, MT, Director of ContentCategories: Audits/Auditing Billing Claims Compliance Denials & Denial Management Documentation Guidelines Evaluation & Management (E/M)
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.
###
Questions, comments?
If you have questions or comments about this article please contact us. Comments that provide additional related information may be added here by our Editors.
Latest articles: (any category)
COVID Vaccine Coding Changes as of November 1, 2023October 26th, 2023 - Wyn Staheli
COVID vaccine changes due to the end of the PHE as of November 1, 2023 are addressed in this article.
Medicare Guidance Changes for E/M ServicesOctober 11th, 2023 - Wyn Staheli
2023 brought quite a few changes to Evaluation and management (E/M) services. The significant revisions as noted in the CPT codebook were welcome changes to bring other E/M services more in line with the changes that took place with Office or Other Outpatient Services a few years ago. As part of CMS’ Medicare Learning Network, the “Evaluation and Management Services Guide” publication was finally updated as of August 2023 to include the changes that took place in 2023. If you take a look at the new publication (see references below),....
Can We Score Interpretation of an EKG Towards E/M Medical Decision Making?October 10th, 2023 - Aimee Wilcox
When EKGs are performed in the facility setting or even in the physician's office, what are the requirements for reporting the service and who gets credit for scoring data points for Evaluation and Management (E/M) medical decision making (MDM)? Let's take a look at a few coding scenarios related to EKG services to get a better understanding of why this can be problematic.
Accurately Reporting Signs and Symptoms with ICD-10-CM CodesOctober 5th, 2023 - Aimee Wilcox
Coders often find themselves unsure of when to report a sign or symptom code documented in the medical record. Some coders find their organization has an EHR that requires a working diagnosis, which is usually a sign or symptom, be entered to order a test or diagnostic study or image. Understanding the guidelines surrounding when signs and symptoms should be reported is the first step in correct coding so let's take a look at some scenarios.
The 2024 ICD-10-CM Updates Include New Codes for Reporting Metabolic Disorders and Insulin ResistanceSeptember 19th, 2023 - Aimee Wilcox
Diabetes is a chronic disease that just seems to consistently be increasing instead of improving resulting in a constant endeavor by medical researchers to identify causal effects and possible treatments. One underlying or precipitating condition that scientists have identified as a precipitating factor in the development of diabetes is insulin resistance, which is a known metabolic disorder. As data becomes available through claims reporting, additional code options become possible with ICD-10-CM.
Documenting and Reporting Postoperative VisitsSeptember 12th, 2023 - Aimee Wilcox
Sometimes we receive questions regarding documentation requirements for specific codes or coding requirements and we respond with information and resources to support our answers. The following question was recently submitted: Are providers required to report postoperative services on claims using 99024, especially if there is no payment for that service? What documentation is required if you are reporting an unrelated Evaluation and Management (E/M) service by the same physician during the postoperative period?
Understanding Gastroesophageal Reflux Disease and ICD-10-CM CodingAugust 22nd, 2023 - Aimee Wilcox
Gastroesophageal reflux disease or GERD for short, is a disease that impacts millions of Americans on a weekly basis. Symptoms are uncomfortable, as are some of the tests used to diagnose it, but understanding the disease, tests, and treatments helps us better understand how to code the disease using ICD-10-CM codes.
