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Basic Resources for Every Urology Practice
AUA Services for Coding & Reimbursement
Coding Books, Newsletters and Software
Medicare Informational Resources
Informational Web Sites
AUA Services for Coding and Reimbursement
The AUA offers many services to assist physicians and their staff members to accurately and efficiently code claims to Medicare and other third-party insurance companies.
Coding Tips for the Urologist's Office. Each year the AUA provides Coding Tips on line as a free service. This informative guide offers education on new CPT®, ICD-9, HCPCS codes. It is an important resource for the physician as well as the billing and coding staff. We have improved the chart of most frequently billed urology CPT® codes by converting it to an electronic Medicare fee calculator based on your Medicare region. When accessing this chart, you need only select your Medicare region or state to automatically generate a list of the 100 most frequently billed Medicare allowables for your practice. This is a very helpful tool to assure proper payment from your Medicare carrier.
Coding Hotline. The AUA has Certified Professional Coders (CPC) on staff to assist you with difficult coding problems and coverage issues. Subscribers to the Practice Managers' Network (PMN) have unlimited free access to this service. Questions from non-subscribers will be answered for a nominal charge. There are several ways to submit specific coding questions: by telephone 866-746-4282 (Option 2), by fax to 410-689-3907 or by e-mail at codinghotline@AUAnet.org. Operative reports, explanation of benefits (EOB) and other documentation and correspondence should accompany coding inquiries between your practice and the payer. Make sure all patient information has been deleted to comply with HIPAA regulations. To subscribe to the PMN, call 866-746-4282 (x 3924) for an application.
AUA Coding Today is a valuable on-line resource to assist in finding appropriate CPT®/ICD-9-CM/HCPCS, coding state specific Medicare payment information, global periods and bundling edits. The AUA in conjunction with Physicians Reimbursement Systems has developed this useful tool as a free service to all AUA members and Practice Managers' Network (PMN) subscribers. Click here for instructions on registering for this free service.
Coding Education. Because coding rules are continually changing, even the best coders must strive to stay on top of all the new coding and payment rules affecting your practice. By investing in their continuing education each year, your practice will see a difference in accuracy and in reimbursements.
- The AUA offers comprehensive sessions on coding for Evaluation and Management (E&M) services and urology procedural services held at regional seminars around the country.
New CPT® Codes. Recommendations for new urological CPT® codes should be submitted to:
Chairman, Coding and Reimbursement Committee
American Urological Association
Reimbursement Systems Manager
American Urological Association
1000 Corporate Boulevard
Linthicum, Maryland 21090
payment@AUAnet.org
or
Fax: 410-689-3907
The AUA Government Affairs Department will present recommendations for new CPT® codes to the AUA Coding and Reimbursement Committee at their semi-annual meeting to determine whether the recommendation meets the following criteria for a new CPT® code:
- technology is FDA approved
- proven efficacious in peer-reviewed literature
- accepted or recognized procedure anticipated to become a standard service/practice
Coding Essentials — Updated Every Year! Regardless of whether the urology practice consists of one physician or a multi-specialty group, the urologist and the billing staff need specific resources for everyday use. Your practice should renew these four coding books every year:
- The current year's CPT® - Physician's Current Procedural Terminology, 4th Edition. This reference guide is an essential tool of the urology practice and lists all of the current physician's procedural and E&M codes necessary for correct coding.
- The current year's ICD-9-CM - International Classification of Diseases, 9th Revision, Clinical Modification, Diseases Tabular List (Volume 1) and Diseases Alphabetical Index (Volume 2), which lists all the diagnosis codes used by physicians. If your practice does hospital billing, you will also need the ICD-9 Procedural Code book that lists all the ICD-9-CM hospital procedural codes.
- The current year's HCPCS - Healthcare Common Procedure Coding System.
- The current year's Medicare RBRVS: The Physician's Guide, which is a guide to relative values for all HCPCS and CPT® codes.
These four publications are a small investment and provide invaluable information. Renewed annually, they will save hours of miscoding, denied claims and lost reimbursements. These books come in various formats including hardbound, softbound, computerized disk and magnetic tape. It is important that your tools fit your methods of billing. AUA Coding Today has all this information at your fingertips.
National Correct Coding Initiative (CCI) Coding Edits
This is an essential tool for a urology office that bills services for the Medicare population. The CCI edits are maintained through CMS's. The CCI edits outline comprehensive and component code pairs for billing Medicare claims. The AUA Coding Today also offers currently quarterly CCI edits as a free service to AUA members and PMN subscribers. The National Technical Information Service (NTIS), a federal government office, offers the complete National Correct Coding Policy Manual in Comprehensive Code Sequence for Part B Medicare Carriers for all edits for a nominal fee. You may order this publication by calling 800-363-2068 or on line at www.ntis.gov/product/correct-coding.htm. CCI edits are also available free of charge by accessing the CMS web site at www.cms.hhs.gov/physicians/cciedits. This information is also available through AUA Coding Today.
If an edit is found that is inappropriate, please contact the AUA Government Affairs Department at 410-689-3780. The edit will be presented to CMS and AdminaStar for reconsideration.
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Coding Books, Newsletters and Software
The following resources will assist your office in understanding CPT® coding, Medicare payment policy and the national Medicare Fee Schedule for all procedures. This listing is not all inclusive and is for informational purposes only. AUA does not endorse any specific product.
- Coding Companion for Urology-Nephrology (formerly Coding Illustrated, Genitourinary System), a book developed by Ingenix, Inc., which provides an illustration and layman's explanation of all the genitourinary CPT® codes. Also listed with each code are the most commonly associated ICD-9 codes as well as billable HCPCS Level II codes for outpatient services. To order, call 877-464-3649.
- Coding News, a newsletter devoted to ICD-9 coding issues. To order, call 800-825-7421.
- Part B News, a newsletter dedicated to Medicare policy and reimbursement news. To order, call 877-602-3835. (Note: AUA members receive a discount when subscribing to this publication.)
- Urology Coder's Pink Sheets, a newsletter specifically dealing with urology coding issues. To order, call 877-602-3835. (Note: AUA members receive a discount when subscribing to this publication.)
- CPT® Assistant, an American Medical Association (AMA) newsletter that provides articles on coding as well as answers to common coding questions. To order, call Ingenix 800-621-8335.
- Electronic billing resources can help if your practice submits claims electronically. Your Medicare carrier offers a software package at cost that allows you to print and view claims in a Medicare standard format. For more information, contact your carrier and ask about the American National Standards Institute ASCX12835 Electronic Claims Remittance Form (PC-Print-V). (Visit http://cms.hhs.gov/contacts/incardir.asp for a telephone and website listing of Medicare Carriers' Medical Directors.)
- 2006 Customized Fee Analyzer, Urology. Published by Ingenix provides a customized report with relative and actual charge data-completely updated for 2006-for your specialty and zip code. Call 1-800-INGENIX (464-3649), Option 1 or visit their web site at http://www.ingenixonline.com/modules/catalog/catalog_product.asp?ProductID=20104&CategoryID=100040
AAPC. The American Academy of Professional Coders (AAPC) is one of the nation's largest medical coding organizations. For membership or certification information, call 800-626-CODE [2633] or www.aapc.com.
AHIMA. The American Health Information Management Association (AHIMA) is another organization promoting coding through certification and membership. For more information, call 312-233-1100 or www.ahima.org.
Medlearn Network.
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Medicare Informational Resources
Medicare Carrier Advisory Committee. The Centers for Medicare and Medicaid Services (CMS, formerly HCFA) mandates that all carriers maintain an advisory committee made up of physicians from every specialty to allow open communications among providers and payers. This effort has been very successful in many states in clarifying local coding and reimbursement issues. The carrier does not employ these practicing urologists and other physicians rather CAC serves as a contact point to voice urological concerns brought forward from both providers and payers.
The urologist representative on each state Carrier Advisory Committee (CAC) as well as the Medicare Medical Director is listed at www.auanet.org/coding/codingtips/caclist.cfm. The AUA includes these urology CAC members on a committee that meets annually at the AUA Annual Meeting. These urologists were nominated by state medical or urological societies and appointed to serve on the Medicare Carrier Advisory Committee.
Medlearn Network. CMS, which is responsible for the Medicare program, now offers a number of on-line Medicare training courses. CMS also offers other training courses for physician's staff at remote locations. For details about these courses and how to access them, visit http://cms.hhs.gov/medlearn/.
CMS Regional Offices. The United States is divided into ten CMS regions. Medicare Carriers (for physician and hospital services) are insurance companies who bid and are awarded government contracts by CMS to provide claims processing to Medicare beneficiaries within a specified area. These contractors report to the CMS regional offices and to the national CMS office in Baltimore. The regional offices also award durable medical equipment (DME) numbers. For your reference, the addresses of the 10 CMS regional offices are listed at the following web site: http://cms.hhs.gov/about/regions/professionals.asp.
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Informational Web Sites
Centers for Medicare & Medicaid Services (CMS)
http://new.cms.hhs.gov/
CCI edits
http://new.cms.hhs.gov/NationalCorrectCodInitEd/NCCIEP/list.asp#TopOfPage
Medlearn Network
http://www.cms.hhs.gov/MedlearnNetworkGenInfo/
CMS Regional Offices
http://new.cms.hhs.gov/RegionalOffices/01_overview.asp
Advanced Beneficiary Notice
http://new.cms.hhs.gov/BNI/
(?) CPT Utilization Statistical Files
http://new.cms.hhs.gov/NonIdentifiableDataFiles/03_PartBExtractSummarySystem.asp
(?) E & M Documentation Guidelines
http://www.cms.hhs.gov/MedlearnProducts/
Physicians Information Resource
http://new.cms.hhs.gov/center/physician.asp
Physicians' Regulatory Issues Team
http://new.cms.hhs.gov/PRIT/01_overview.asp
HCPCS Coding
http://new.cms.hhs.gov/MedHCPCSGenInfo/01_overview.asp
Program Manuals, Transmittals, and Memos
http://new.cms.hhs.gov/Transmittals/01_overview.asp
RVUs
http://new.cms.hhs.gov/PhysicianFeeSched/01_overview.asp
Medicare Carrier Manual Part III (Physician Billing) Coding Guidelines Chapter 15
http://www.cms.hhs.gov/Manuals/PBM/itemdetail.asp?filterType=none&filterByDID=-99&sortByDID=1&sortOrder=ascending&itemID=CMS0219211
Medicare Carriers
http://new.cms.hhs.gov/mcd/index_article_bycontractor.asp
Medicare Regional Offices - DME
http://new.cms.hhs.gov/center/dme.asp
Medicare Regional Offices - Problems w/ Medicare
http://new.cms.hhs.gov/RegionalOffices/01_overview.asp
Interactive Medicare Coding & Billing Training for Staff
http://cms.meridianksi.com/kc/main/kc_frame.asp?kc_ident=kc0001&loc=1
Medicare Participating Physician Directory
http://www.medicare.gov/Physician/Search/PhysicianSearch.asp?CookiesEnabledStatus=True
Medicare Coverage Database
http://new.cms.hhs.gov/mcd/search.asp?
UPIN Numbers for Referring Physician
http://new.cms.hhs.gov/NonIdentifiableDataFiles/08_UniquePhysicianIdentificationDirectory.asp#TopOfPage
American Medical Association
http://www.ama-assn.org
CPT® Information and Education
http://www.ama-assn.org/ama/pub/category/3884.html
Food and Drug Administration
http://www.fda.gov
List of drugs and corresponding NDC codes
http://www.fda.gov/cder/ndc/
Office of Inspector General - Compliance guidelines, provider exclusion lists
http://oig.hhs.gov
Database of drugs, uses, generic/brand names
http://www.webmd.com/drugs/index-drugs.aspx
On-line Medical Dictionary
http://medical-dictionary.com/
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CPT® is a registered trademark of the American Medical Association.
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