2008 Correct Coding Initiatives

American Association of Clinical Endocrinologists
Practice Management
February 27-28, 2015
Vanessa Lankford, CPC, CMCO, CMOM, AACE-CEC
Practice Management Coordinator
American Association of Clinical Endocrinologists
General Disclaimer
All medical coding must be supported with documentation and medical necessity.
**While this department represents our best efforts to provide accurate information
and useful advice, we cannot guarantee that third-party payers will recognize and
accept the coding and documentation recommendations. As CPT®, ICD-9-CM
and HCPCS codes change annually, you should reference the current CPT®, ICD9-CM and HCPCS manuals and follow the "Documentation Guidelines for
Evaluation and Management Services" for the most detailed and up-to-date
This information is taken from publicly available sources. The American
Association of Clinical Endocrinologists cannot guarantee reimbursement for
services as an outcome of the information and/or data used and disclaims any
responsibility for denial of reimbursement. This information is intended for
informational purposes only.
Current Procedural Terminology (CPT®) is copyright and trademark of the 2014
American Medical Association (AMA). All Rights Reserved. No fee schedules,
basic units, relative values, or related listings are included in CPT®. The AMA
assumes no liability for the data contained herein. Applicable FARS/DFARS
restrictions apply to government use.
Learning Objectives
• Manage the need for prior authorization in
terms of reimbursement
• Evaluate report requirements for billing
• Determine coding for coverage
Prior Authorizations
• Definition of a prior authorization
• Discuss types of authorizations
Management of Prior Authorizations
• Centralize responsibilities in office
• Maximize EHR Capabilities
• Maintain top payers authorization requirements
• Utilize Web Portals
Report Requirements for Billing
• Define Medical Necessity according to CMS
• Elements expected on an encounter
• Clear, consistent, concise documentation
Reimbursement According to:
• Federal Carriers
• Commercial Carriers
Medicare’s Guidelines
• Conditions of Coverage
• Frequency Standards
• Beneficiaries Who May be Covered
• What’s not covered?
• Claims processing
General Coding Guidelines
• CPT® Codes
• Common Diagnosis Codes
• Brief discussion of ICD10 Changes
• Screening verses diagnostic services
Reimbursement and Appeals
• National Medicare Reimbursement Averages
• Professional – Technical – Global Services
• Appeals
 Coding and billing do not go hand in hand
 Read your commercial contracts- know
expectations and administrative guidelines for
your negotiated services and procedures
 Ensure EVERYONE involved with the billing and
coding for the office understand the False
Claims Act and it’s importance
Be familiar with your MAC- your LCD (local
coverage determinations) and the NCD (national
coverage determinations)
Codes change and are updated each year- obtain
current books
Be familiar with coding books’ coding conventions
and guidelines
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