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When billing for services performed by a physician, several coding resources are used. Each practice may use a variety of billing publications and resources; however, the basic billing tools include the Current Procedural Terminology (CPT), the Healthcare Common Procedure Coding System (HCPCS), and International Classification of Diseases, 9th Revision, Clinical Modification (ICD-9-CM).
In order to bill appropriately for services and assign correct diagnosis codes, it is imperative to have the most up-to-date coding materials. Physicians should purchase updated coding publications every year to ensure that their billing and coding systems are accurate. Here is a brief overview of the publications mentioned, the available dates, and the effective dates for each.
The CPT book provides a method of reporting physician services by identifying and describing medical services. The American Medical Association (AMA; Chicago, IL) publishes the CPT book annually, and changes are effective on January 1 of each year. CPT codes are recognized nationally by public and private payers, and annual changes in CPT are typically recognized by these payers. The CPT book is typically available for purchase during the month of October.
The AMA publishes many supplements to the CPT book, and two worth noting are CPT Changes: An Insider's View and CPT Assistant. The first publication provides a detailed review of the current year's additions, revisions, and deletions to CPT. The latter guide is published monthly and is the official companion to the CPT book.
The HCPCS contains codes identifying medical services, supplies, and items that are not represented by CPT codes. The HCPCS codes begin with a letter followed by four numbers. These codes include Medicare G-codes, E-codes for durable medical equipment, S-codes for temporary national services, and J-codes for drugs.
This publication is updated annually and is effective January 1 of each year. HCPCS codes are recognized by Medicare, Medicaid, and most other payers, and changes in HCPCS codes are typically recognized by these payers. The publication is available from a number of private sources, but is typically available for purchase in December.
The ICD-9-CM has three volumes. Volumes 1 and 2 list codes for various diagnoses. Volume 3 consists of codes for procedures and is used by hospitals.
This publication is updated annually, and changes are effective October 1 of each year. ICD-9-CM codes are recognized by public and private payers. This publication is typically available for purchase in September.
The official publication for ICD-9-CM coding guidelines and advice is the Coding Clinic for ICD-9-CM. This publication is available through the American Hospital Association Central Office on ICD-9-CM, and is published quarterly.
As a reminder, the Centers for Medicare & Medicaid Services (CMS) no longer allows a 90-day grace period to report old ICD-9-CM codes. Medicare carriers and fiscal intermediaries will not accept discontinued ICD-9-CM codes on claims with dates of service after the October effective date.
ASCO is currently updating its publication, Practical Tips for the Practicing Oncologist. The 4th edition will offer answers to the most frequently asked questions about coding, reimbursement, and regulatory policies affecting oncology practices. The new edition will be renamed Practical Tips for the Oncology Practice and is expected to be available in the first quarter of 2007.
The Centers for Medicare & Medicaid Services (CMS) will implement a payment hold on all paper and electronic claims including initial, adjusted, and Medicare Secondary Payer (MSP) claims. The payment hold was mandated by the Deficit Reduction Act of 2005.
Claims will be held from September 22, 2006, through September 30, 2006. During this 9-day period, interest will not be accrued or paid for delayed payment. CMS states that payment for claims held will be made on October 2, 2006.
More detailed information on this payment hold can be found in CMS Transmittal 944, dated May 10, 2005, at http://www.cms.hhs.gov/Transmittals/downloads/R944CP.pdf.
The corresponding Medicare Learning Network (MLN) Matters article can be found at http://www.cms.hhs.gov/MLNMattersArticles/downloads/MM5047.pdf.