Healthcare fraud and abuse are hot topics right now, it’s more important than ever to get on top of new codes and keep your practice audit-ready. Knowledge is power. This handy list will help you update CPT codes and stay current. Educate providers and staff using the following auditing resources.
Stay Audit-Ready and Current with This Convenient Resource List
Sources that will provide additional information to CPT codes are:
CPT Changes: An Insider’s View
Clinical Examples in Radiology
Center for Medicare and Medicaid Services (CMS):
Medicare Claims Processing Manual, Chapter 13 – Radiology Services and Other Diagnostic Procedures
Medicare Benefit Policy Manual, Chapter 15: Section 80.6 - Requirements for Ordering and Following Orders for Diagnostic Tests
Medicare National Coverage Determinations (NCD)
Local Medicare Administrative Contractors (MACs) Coverage Determinations (LCD)
Review the Office of Inspector General (OIG) yearly work plan
American College of Radiology (acr.org)
Quality and Safety
Clarification on Ordering of Diagnostic Tests Rule
ICD 10 CM Coding Guidelines
ICD 10 CM Guidelines and Yearly Updates
Example: Conventions for the ICD-10-CM: 19. Code assignment and Clinical Criteria. The assignment of a diagnosis code is based on the provider’s diagnostic statement that the condition exists. The provider’s statement that the patient has a particular condition is sufficient. Code assignment is not based on clinical criteria used by the provider to establish the diagnosis.
The Medicare Claims Processing Manual, Chapter 13, has several examples of diagnosis coding scenarios.
AAPC Coder Software Application is an excellent and quick resource for CPT/ICD-10/HCPCS/Modifiers/CPT Assistant/Code Assist/AHA Coding Clinic and AAPC Coder Survival Guides.
Can’t get enough info about updating your CPT codes and staying forever audit-ready? I don’t blame you.