The Revised CMS-1500 Form
ATCMS Seminar
March 30, 2014
By Ling Zheng, L.Ac.
The Revised CMS-1500 Form
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General information regarding the
revised CMS-1500 form
What are the differences between the
CMS-1500 form (02/12) and the CMS1500 form (08/05)
How to fill out the new form
How to get the new form and the online
information
General Information
The Office of Management and Budgets
(OMB) has approved a revised CMS-1500
health insurance claim form (version
02/12) to replace the current form (version
08/05). Healthcare providers are required
to use the revised CMS-1500 form for their
medical reimbursement since April 1, 2014
How to fill out the new form
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What are differences between
the revised form and the
original one
How to fill out the changed
items on the revised claim form
How to fill out the new form
Add a QR Codes symbol to the top,
left hand margin of the claim form
How to fill out the new form
Item 1:
Minor changes to the wording of
payer ID number requirements
How to fill out the new form
Item 8:
Changed to “RESERVED FOR NUCC USE”,
Removed “PATIENT STATUS” from the
original form
Description: This field is reserved for
NUCC use
How to fill out the new form
Item 9b and 9c:
Replaced with “RESERVED FOR NUCC
USE”
Removed “EMPLOYER’S NAME OR SCHOOL
NAME” from the original form
Description: The field is reserved for NUCC
(National Uniform Claim Committee) use
How to fill out the new form
Item 10d:
Changed to “CLAIM CODES
(Designated by NUCC)”
Instruction: When applicable, use to
report appropriate claim codes
designated by the NUCC
How to fill out the new form
For the workers’ Compensation claims,
condition Codes are required when
submitting a bill that is a duplicate or
an appeal. (Original Reference Number
must be entered in Box 22 for these
conditions). Note: Do not use
Condition Codes when submitting a
revised or corrected bill.
How to fill out the new form
Original claim: None
Duplicate claim: W2
Appeal-Level 1: W3
Appeal-Level 2: W4
Appeal-Level 3: W5
How to fill out the new form
How to fill out the new form
Item 11b:
Changed to “OTHER CLAIM ID
(Designated by NUCC)”
Instruction: For workers’ compensation or
property & casualty (such as No-Fault),
should enter qualifier “Y4” and claim
number assigned by the payer
How to fill out the new form
How to fill out the new form
Item 14:
Minor changes to layout of field
Instruction: Enter the first date of the
present illness, injury, or pregnancy (LMP),
then enter the following applicable qualifier
Onset of current symptoms or illness: 431
Last menstrual period: 484
How to fill out the new form
How to fill out the new form
Item 15:
Changed to “OTHER DATE”
Removed “IF PATIENT HAS HAD SAME OR
SIMILAR ILLNESS, GIVE FIRST DATE”
from the original form
Instruction: May enter the qualifier “454”,
then enter the date of the initial treatment
How to fill out the new form
How to fill out the new form
Item 17:
Added a field to report a qualifier to identify
which provider is being reported
Instruction: Enter the name of provider who
referred or ordered the service on the
claim, then enter the applicable qualifier to
identify which provider is being reported
How to fill out the new form
DN
DK
DQ
Referring provider
Ordering provider
Supervising provider
How to fill out the new form
How to fill out the new form
Item 19:
Replaced with “ADDITIONAL CLAIM
INFORMATION (Designated by NUCC)”
Removed “RESERVED FOR LOCAL USE”
from the original form
Instruction: Don’t need to fill it unless it is
required
How to fill out the new form
Item 21:
Added eight additional lines for diagnosis
of illness/injury
Instruction:
Enter the applicable ICD indicator to
identify which version of ICD codes is
being reported, in the upper right-hand
portion of the field
How to fill out the new form
ICD Indicator:
9
0
ICD-9-CM
ICD-10-CM
How to fill out the new form
Enter the ICD codes to identify
the patient’s diagnosis and/or
condition. List no more than 12
ICD-9-CM or ICD-10-CM codes
relating to the service(s) on the
claim
How to fill out the new form
How to fill out the new form
Item 24E: DIAGNOSIS POINTER
Instruction:
Enter the diagnosis code reference letter
(such as AB…) as shown in item 21 to
relate the date of services and the
procedures performed.
The field allows for the entry of up to 4
characters in unshaded area
How to fill out the new form
How to fill out the new form
Item 30:
Replaced with “Rsvd for NUCC Use”
Removed “BALANCE DUE” from the
original form
Description: This field is reserved for
NUCC use
How to get the new claim form
How to get the CMS-1500-Form
(version 02/12)?
May order the forms at:
www.medicalartspress.com
Online reference information
Reference Information:
Please read <<1500 Health
Insurance Claim Form Reference
Instruction Manual for Form Version
02/12>> provided by National
Uniform Claim Committee (NUCC)
Online reference information
The online information is
available at:
http://www.findacode.com/cms1
500-claim-form/instructions-0212/1500_claim_form_instruction
_manual_2012_02.pdf
The Revised CMS-1500 Form
Thank you !
ICD-10-Codes Commonly
Used By Acupuncturists
ATCMS Seminar
March 30, 2014
By Ling Zheng, L.Ac.
Highlights of the talk
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General information regarding ICD-10Coding system
To introduce <<List of ICD-10 Codes
Commonly Used by Acupuncturists>>
Acupuncture coverage policy provided by
different major insurance companies
Online information regarding ICD-10Codes
General Information
Brief introduction of ICD-10-CM
 ICD-10-CM Coding system
 What are differences between
ICD-10-CM and ICD-9-CM
 The deadline for using the ICD10-Codes
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Brief Introduce ICD-10-CM
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ICD Codes: International Classification of
Diseases (ICD) codes is a coding system
to indicate diagnoses, symptoms, injuries,
and other conditions. This coding system
is developed and published by WHO.
ICD-10: is the 10th revision of ICD coding
system developed by WHO on January 1,
1999
Brief Introduce ICD-10-CM
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ICD-10-CM: Based on ICD-10 coding
system published by WHO, U.S.
Government (the National Center for
Health Statistics, NCHS) published the
ICD-10-CM (International Classification of
Diseases, 10th revision, Clinical
Modification) on January 1, 2014.
ICD-10-CM Coding System
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ICD-10-CM is an alphanumeric
classification system. It consists of up to 7
characters.
The first character is a letter followed by
numbers or alpha characters.
The injury-ICD-code should be added an
appropriate 7th alpha character (such as A,
D, or S) according to the different statuses
What are differences between
ICD-10-CM and ICD-9-CM
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ICD-10-CM codes consist of up to 7
alphanumeric characters, and ICD-9-CM
codes consist of up to 5 alphanumeric
characters only
ICD-10-CM contains subcategories
codes to indicated conditions on right
side or left side, and upper or lower
extremity
What are differences between
ICD-10-CM and ICD-9-CM
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Expanded injury codes
Add the 7th alpha character on injury
codes to describe patients’ status
Add the external cause codes to describe
the cause, the intend, the place of injury
occurrence
When Should I Use ICD-10-CM
Since October 1, 2014,
healthcare providers are
required to use ICD-10-CM
codes for medical
reimbursements
ICD-10-CM Codes Commonly
Used by Acupuncturists
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Why dose ATCMS provide the <<List of
ICD-10-Codes Commonly Used by
Acupuncturists>> to our AOM
colleagues?
To help AOM practitioners using the new
ICD codes easily and correctly, ATCMS
offer this reference coding material to
our colleagues
ICD-10-CM Codes Commonly
Used by Acupuncturists
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The reference coding material has listed
about 400 ICD-10-CM codes commonly
used by acupuncture practitioners
Considering the purpose of acupuncture
reimbursements, the listed codes have
been divided to the following three
parts: (1) Pain and related conditions;
(2) Injuries; and (3) Other conditions
Part I: Pain and the Related
Conditions
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Pain management is the most common
case treated at acupuncture clinic
In general, some major insurance
companies consider acupuncture as a
medically necessary procedure for
treating pain and the related conditions,
such as osteoarthritis, migraine, neck
pain or lower back pain
Part II: Injuries
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Injuries is common cases treated at
acupuncture clinic also
These ICD codes are used for
acupuncture reimbursements on NoFault or workers’ compensation cases
Some major insurance policies also
cover acupuncture for injuries
Part II: Injuries
All injury codes should be 7character-codes
 The 7th character of injury
codes should be a letter “A”,
“D”, or “S”, according to the
following different statuses:
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Part II: Injuries
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For the status of initial encounter, the
7th character of the code should be “A”
For Example:
Strain of unspecified muscle and
tendon at right leg level with the status
of initial encounter, the ICD code
should be “S86.911A” (S86.911 plus A)
Part II: Injuries
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For the status of subsequent encounter,
the 7th character of the code should be “D”
For Example:
Strain of unspecified muscle and tendon at
right leg level with the status of
subsequent encounter, the ICD code
should be “S86.911D” (S86.911 plus D)
Part II: Injuries
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For the status of sequel, the 7th character
of the code should be “S”
For Example:
Strain of unspecified muscle and tendon
at right leg level with the status of
sequel, the ICD code should be
“S86.911S” (S86.911 plus S)
Part II: Injuries
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If the injury code with fewer
than six characters, it requires
the placeholder “X” to fill the
missing between the code and
the above 7th alpha character
Part II: Injuries
Example-1:
Sprain of unspecified site of right
knee with the status of initial
encounter, the ICD code should be
“S83.91XA” (to fill X between 5character-code S83.91 and the 7th
alpha character A)
Part II: Injuries
Example-1:
Sprain of muscle, fascia and tendon
at neck with the status of
subsequent encounter, the ICD
code should be “S16.1XXD” (to fill
XX between 4-character-code S16.1
and the 7th alpha character D)
External Cause Codes
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External cause codes: describe the
cause, the intent, the place of
occurrence, and if applicable, the
activity of the patient at the time of the
event, and the patient’s status, for all
injuries
These codes may be used with the
injury codes
External Cause Codes
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External cause codes can be
used as many as necessary to
full explain each cause
They should be used with the
related injury codes, and can
never be a principal (first listed)
diagnosis
External Cause Codes
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There is no national requirement
for mandatory ICD-10-CM external
cause code reporting
However, it may be helpful for the
insurance reimbursement on the
WC or NF cases
External Cause Codes
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External cause codes should be 7character-codes
The 7th character of these codes should
be an alpha character (such as “A”, “D”,
or “S”) according to the different
statuses
May need to add the placeholder “X” to
fill the missing as the injury codes
Part III: Other Conditions
Some major insurance policies consider
acupuncture as a medically necessary
procedure for the following conditions:
R11.2 Post-operative or chemotherapyinduced nausea and vomiting
O21.9 Vomiting of pregnancy,
unspecified
Part III: Other Conditions
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However, other ICD codes listed on this
part may NOT be considered as a suitable
condition for acupuncture treatment,
according to the current policies provided
by most major insurance companies
Try to avoid using these codes unless
confirming they are covered conditions
Acupuncture Coverage Policy
Provided by Some Major Ins. Co.
Empire Blue Cross & Blue
Should
 Cigna
 Aetna

Acupuncture Coverage Policy
Provided by Some Major Ins. Co.
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Each insurance company may have
different plans which provide different
acupuncture coverage policies
Strongly urge acupuncturists to verify
every individual patient’s acupuncture
benefits before accepting his/her
insurance plan
Online Information
for ICD-10-CM Codes
Please visit:
www.icd10data.com
For more ICD codes information
by entering the diagnosis or
symptoms
ICD-10-CM Codes
Question
&
Discussing
ICD-10-CM Codes
Thanks!