FAQs

To see the ICD-9 Vol 1 codes typically reported to insurers for a CPT® surgical code, go to the CPT® code's details page and look on the right hand column's tool bar area under ICD-9 Vol1 CrossRef.

SuperCoder.com offers online medical coding information including code lookup, medical coding tools, and coding newsletters from the Coding Institute, LLC. Coders, physicians, insurers, and billers rely on SuperCoder to access official code descriptors and guidelines, how-to coding articles, coding questions, and coding crosswalks that streamline coders and billers work and improve coding accuracy, compliance, and profitability.

Code Search: Simultaneously search across 4 codesets (CPT®, HCPCS, ICD-9, and ICD-10-CM). Identify the correct code easier thanks to coding analyst weighted search results that show you the most likely codes first and insight provided with official code descriptors, coding guidelines, Lay Terms, and Illustrations.

Fast Coder: Boost modifier, CCI, and LCD compliance with code search plus four compliance tools including Allowed Modifiers, CCI Edits Checker, LCD Lookup, and CPT® <-> HCPCS.

Coding Newsletters: A monthly* subscription to a Coding Alert provides essential coding updates, innovative case studies, and revenue-boosting tips all specific to your specialty. Choose from 30+ specialties offered in two convenient formats: online or online plus print. Quickly get the on-target specialty-specific info you need thanks to keyword and code searchable archives of your Coding Alert included with each Coding Newsletter subscription.
* Part B Insider is a weekly publication on Medicare regulations and multispecialty coding.

Physician Coder: Unleash the full power of SuperCoder with online code search plus six compliance tools all connected to a Coding Alert subscription. You'll get all the growing accuracy-improving coding education you need tied to Allowed Modifiers, CCI Edits Checker, LCD Lookup, 7-in-1 Fee Schedules, and ICD-9 CrossRef.

Facility Coder: Inpatient facility and outpatient facility coders get all the added code search and coding tools they need to keep their hospital coding or ambulatory surgery center (ASC) coding compliant. No hassles switching between Part A and Part B sites thanks to everything from Physician Coder plus DRG or APC code search, monthly facility-specific advice, and facility coding tools.

Ask an Expert: Save time researching your coding questions with expert coding answers to your coding questions delivered to the forum within 24 hours on business days. Pick from annual subscriptions that allow you to submit 5, 10, or 15 questions each month.

SuperCoding On-Demand: Struggling with an op report? Let the Coding Institute's education experts provide the solution-HIPAA secure! Simply submit a single question whenever you need a coding expert solution. Receive your answer right in your inbox within 24 hours M-F.

Code Connect: Combats denials with official guidance on CPT® codes from the AMA. Search by code for CPT® Assistant coding articles from 1990 to the present. Stedman's Medical Dictionary: Look up thousands of medical terms to properly credit your physician's documentation.

Survival Guides: Jump start your understanding of top coding errors including official coding guidelines, Medicare regulations, and private payer variations with 10 specialty procedural and 4 codeset specific coding encyclopedias.

CEUs: Earn up to 38 annual CEUs from AAPC or 10 annual CEUs from AHIMA. Tune into your monthly Coding Alert, Webinar Archives, and bimonthly coding news in SuperCoder Bolt and then pass an online quiz to collect each CEU certificate.

With SuperCoder, you get online medical coding information sorted and analyzed by education experts from the unbiased Coding Institute. You code faster, better thanks to tons of medical coding advice and official guidance at your fingertips. This user-friendly site is designed and updated by certified coders so you always have the most up-to-date coding guidance and reliable experts you can turn to at any time.

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The Coding Institute is SuperCoder.com's parent company.

SuperCoder.com has grown by leaps and bounds since its original conception as Coding 411 not more than a decade ago. SuperCoders roots go back 60+ years to the founding of the Coding Institute and its national recognized coding experts who bring 110 years of combined coding expertise to coders, physicians, and payers. In addition to SuperCoder, the Coding Institute’s other sister divisions include AudioEducator and Eli HealthCare.

Logged in users can determine their status under My SuperCoder>Profile Click on the Subscription tab for detailed historical information about your purchases and subscription term.

Registration is FREE. Simply supply your email and you get instant access to coding news, Webinar Now Playing, searchable Medicare Transmittals, Job Board, and Coding 911. Subscribers are paid users who have bought a monthly or annual subscription and have access to CEU opportunities and Archived Webinars.

If you have a question about the coding content or coding tools data at any time, email CustomerService@SuperCoder.com. SuperCoder's coding specialists will research your question and provide support for our findings through the Customer Service department. For answers to coding questions, subscribe to Ask an Expert for monthly topic-specific questions submission and SuperCoding On-Demand for op report and individual coding question submission.

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A valid credit card is required. We will not charge your credit card until 7 days. You can cancel your trial with no charge up to 5 days prior to the end of your trial.

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Code Search: Simultaneously search across 4 codesets (CPT®, HCPCS, ICD-9, and ICD-10-CM). Identify the correct code easier thanks to coding analyst weighted search results that show you the most likely codes first and insight provided with official code descriptors, coding guidelines, Lay Terms, and Illustrations.

Fast Coder: Boost modifier, CCI, and LCD compliance with code search plus four compliance tools including Allowed Modifiers, CCI Edits Checker, LCD Lookup, and CPT® <-> HCPCS.

Coding Newsletters: A monthly* subscription to a Coding Alert provides essential coding updates, innovative case studies, and revenue-boosting tips all specific to your specialty. Choose from 30+ specialties offered in two convenient formats: online or online plus print. Quickly get the on-target specialty-specific info you need thanks to keyword and code searchable archives of your Coding Alert included with each Coding Newsletter subscription.
* Part B Insider is a weekly publication on Medicare regulations and multispecialty coding.

Physician Coder: Unleash the full power of SuperCoder with online code search plus six compliance tools all connected to a Coding Alert subscription. You’ll get all the growing accuracy-improving coding education you need tied to Allowed Modifiers, CCI Edits Checker, LCD Lookup, 7-in-1 Fee Schedules, and ICD-9 CrossRef.

Facility Coder: Inpatient facility and outpatient facility coders get all the added code search and coding tools they need to keep their hospital coding or ambulatory surgery center (ASC) coding compliant. No hassles switching between Part A and Part B sites thanks to everything from Physician Coder plus DRG or APC code search, monthly facility-specific advice, and facility coding tools.

Ask an Expert: Save time researching your coding questions with expert coding answers to your coding questions delivered to the forum within 24 hours on business days. Pick from annual subscriptions that allow you to submit 5, 10, or 15 questions each month.

Code Connect: Combats denials with official guidance on CPT® codes from the AMA. Search by code for CPT® Assistant coding articles from 1990 to the present.

Stedman's Medical Dictionary: Look up thousands of medical terms to properly credit your physician’s documentation.

Survival Guides: Jump start your understanding of top coding errors including official coding guidelines, Medicare regulations, and private payer variations with 10 specialty procedural and 4 codeset specific coding encyclopedias.

Save money with annual pricing offered on all of the above listed products. Code Search and Fast Coder are available as a monthly or an annual subscription.

Code search includes 4 codesets: CPT®, ICD-9-CM Volumes 1 and 2, HCPCS level II, and ICD-10-CM codes.

Coding Tools and Coding Solutions provides 5-ways to search for a code including:

• KEYWORD & CODE SEARCH

Enter code(s) or a keyword (partial, whole, or abbreviation) to show all codes containing that phrase from our proprietary database of 200,000+ terms. For a keyword, SuperCoder ranks the results and lists the code ranges most related to the term first.
Search Tip: To search multiple codes, separate codes using a comma, such as 69210, 382.9, 99213.

• INDEX SEARCH - Electronic

Enter a term (partial or whole) to locate a code using the Alphabetic Index.

• INDEX SEARCH - Manual

Manually look up a term just like in an ICD-9 Coding Manual’s Volume 2 Alphabetic Index.

• RANGE SEARCH

Click on a range of codes to hone in on the code you need.

• DOCUMENT SEARCH

Enter code(s) or keyword(s) (whole or abbreviations) to view a list of codes and articles that contain the code and/or keyword(s).
Coding Newsletters subscribers can search across Coding Alert articles using the Document Search. Enter a keyword or code to locate the selected Coding Alerts and CMS documents to include in the search.

The Centers for Medicare & Medicaid Services (CMS) developed the National Correct Coding Initiative (CCI) to promote national correct coding methodologies and to control improper coding resulting in significant overpayments to physicians. CMS based the CCI edits on coding conventions defined in the American Medical Association's CPT manual, national and local policies and edits, coding guidelines developed by national societies, analysis of standard medical and surgical practices, and a review of current coding practices. CCI edits do not incorporate all edits included in CPT.

SuperCoder.com CCI Edits Checker allows you to check from 2 to 25 CPT and HCPCS codes for applicable CCI edits. The user can check the code combinations allowed for the claim’s date of service going back to 2010. Simply select the applicable quarter form the drop down box. The color-coded system indicates which codes are allowed by CCI to be reported together. The user must also follow current procedural terminology CPT. Color-coded messages indicate:

• Red = These codes cannot be billed together in any circumstances.
• Yellow = These codes can be billed together with a modifier provided documentation and clinical circumstances support overriding the edit with a CCI-allowed modifier, such as modifier 25, 57, or 59.
• Green = There is no bundling issue. User should still check to ensure the combination is allowed per CPT and insurer-specific bundling edits.

The Centers for Medicare & Medicaid Services (CMS) develops numerous fee schedules. SuperCoder's 7-in-1 Fee Schedules tool instantly matches a code to the applicable schedule including Medicare Physician Fee Schedule (PFS), Physician Fee Schedule Modifier Allowances, Medically Unlikely Edits (MUEs), Clinical Diagnostic Laboratory Fee Schedule (CLAB), Average Sales Price (ASP), Average Wholesale Price (AWP), Durable Medical Equipment Prosthetics/Orthotics & Supplies (DMEPOS). The Medicare Physician Fee Schedule is a complete listing of fees that Medicare uses to pay doctors or other providers. The Medicare Physician Fee Schedule is a comprehensive listing of fee maximums used to reimburse a physician and/or other providers on a fee-for-service basis.

SuperCoder.com Fee Schedule shows you the code's national and local payments. You can either enter a code directly under the Coding Tools Fee Schedules link or get the information on a code's detail's page by clicking on the Fee Schedules tab.To use the Medicare Physician Fee Schedule, select your Medicare carrier (you can make your carrier the default carrier for you by selecting the box that says 'Make it default'), and then select the "calculate" button. Search results will display relative value units (RVUs) for a non-facility, facility, modifier guidelines, and the global value for a specific CPT®/HCPCS code.

The Coding Institute is famous for offering coding advice specific to a medical specialty. The articles in SuperCoder.com come from the Coding Institute’s specialty Coding Alert newsletters. Each alert gives coders and physicians practical information on how to accurately and ethically code the common procedures for their specialty. The Coding Institute publishes more than 30 weekly and annual coding newsletters on topics such as ob-gyn coding, orthopedics coding, general surgery coding, urology coding, Medicare Part B coding, medical billing and collections, and more. A Coding Newsletter subscription gives you access to your chosen Coding Alert newsletter for one year including weekly or monthly articles as well as the alert’s complete searchable archives.

To search Coding Alert Archives, click on Coding Newsletters. Coding Solutions subscribers can view articles associated with a code directly on the code's details page as well as recent and top read articles on their specialty's Coder page.

ABN – (Advance Beneficiary Notice of Non-coverage) The ABN is a notice given to beneficiaries of Original Medicare to convey that Medicare is not likely to provide coverage in a specific case. “Notifiers” include physicians, providers (including institutional providers like outpatient hospitals), practitioners, and suppliers paid under Part B (including independent laboratories), as well as hospice providers and religious non-medical health care institutions (RNHCIs) paid exclusively under Part A.

CMS 1500 – The CMS-1500 form (Health Insurance Claim Form) is sometimes referred to as the AMA (American Medical Association) form. CMS-1500 is the prescribed form for claims prepared and submitted by physicians or suppliers (except for ambulance suppliers), whether or not the claims are assigned. Medicare Enrollment Application: Reassignment of Medicare Benefits – An individual who renders services and seeks to reassign his/her benefits to an eligible entity must complete the CMS-855R form for each entity eligible to receive reassigned benefits. The person must be enrolled in the Medicare program as an individual before reassigning his/her benefits. The CMS-855R form may be submitted concurrently with the CMS-855 form.

Medicare Enrollment Application: Physicians and Non-Physician Practitioners – A Physician or Non-Physician Practitioner must complete The CMS-855I form if they render medical services to Medicare beneficiaries. This form is processed through the Medicare carrier. Medicare Enrollment Application: Clinics/Group Practices and Certain Other Suppliers – This application (CMS-855B) is to be completed by a supplier (e.g. ambulance company, physician group, Part B drug vendor) that will bill Medicare carriers for medical services furnished to Medicare beneficiaries. It is not to be used to enroll individuals.

Financial Statement of Debtor – Sole proprietors must use the CMS Financial Statement of Debtor form (CMS-379) to request an extended repayment plan (ERP) for an overpayment debt. Electronic Funds Transfer (EFT) Authorization Agreement – New enrollees are required to complete the most current Electronic Funds Transfer (EFT) authorization agreement (CMS-588). The account must exclusively bear the name of the physician or individual practitioner, or the legal business name of the person or entity enrolled with Medicare. It cannot be a personal account shared with a significant other or any other party.

The Medicare Participating Physician or Supplier Agreement – The CMS-460 form is a formal recognition that you will accept assignment of benefits for all Medicare beneficiaries (patients). It must be submitted either within 90 days of initial enrollment with Medicare OR during the annual Open Enrollment period (typically mid-November through December 31st). Accepting an assignment means you agree to be paid the Medicare allowed amount for services provided to such beneficiaries. Patient's Request for Medical Payment – The Patient’s Request for Medical Payment form (CMS-1490S) is the primary claim form that is filed on the beneficiaries’ behalf (replaces HCFA-1490). This form is used by the beneficiary in order to file a claim with Medicare for services and/or supplies received.

Program transmittals are used to communicate new or revised policies and/or procedures that are being incorporated into a specific Center for Medicare & Medicaid Services (CMS) program manual. The transmittals column in the CMS carrier centre summarizes the revisions to the material, specifically what has been changed.

Under Exclusives>CMS Center, select Transmittals. You can see the latest updates starting from the most recent to the oldest for any revisions that are already in effect or going to take effect soon. You can also use the search box at the top of the page to help you narrow your search down. The search function allows you to search by code or keyword.

Carriers and Medicare Administration Contractors (MACs) audit evaluation and management codes using both the 1995 and 1997 Documentation Guidelines (whichever is more advantageous to the physician). The Evaluation and Management Guidelines (1995 or 1997) used are chosen based on the guidelines that best fit the documentation submitted for the encounter.

This manual contains billing requirements, rules, and regulations as they pertain to Medicare in all settings. The Claims Processing Manuals provide information for such tasks as completing the CMS-1500 claim form used by physical and occupational therapists in private practice. In addition, it provides instructions for the completion of the UB-92 (CMS-1450) claim form used by providers of physical therapy, occupational therapy, and speech-language pathology services in all other settings excluding private practice. It also describes the use of Part B Outpatient Rehabilitation and CORF/OPT Services and other services of the same type.

The CMS Center, LCDs, Coding Alerts, and CEUs are updated weekly. CPT® codes, HCPCS level II codes, APCs, DRGs, and Lay Terms are updated quarterly. The data in the CCI Edits Checker, OPPS Edits, Fee Schedules, OPPS Fee Schedule, IPPS Fee Schedule, and crosswalks are updated on a quarterly basis. The ICD-9-CM codes and Survival Guides are updated annually.

Whenever you see simply click on the button and download a printable sheet. For a code's details page, the PDF will include the Code Descriptor, Lay Term, Coding Guidelines, CPT® Assistant article titles, ICD-9 Vol 1 CrossRef, and Fee Schedules depending on your subscription inclusions. Look for the same button at the top of CPT® Assistant articles. Save PDFs of articles in seconds to show a physician, supervisor, or payer. To email a Coding Alert article, click the blue and white yellow star button to the right of the PDF button.

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Mozilla Firefox is free to download at http://www.mozilla.com/en-US/firefox/ and a breeze to use. In minutes, I converted to Firefox this fall after using Internet Explorer for years. I've never looked back.

Looking for a Diagnosis by Key Term? Follow ICD-9-CM Coding Conventions in SuperCoder.com.
Practice ICD-9-CM Official Coding and Reporting Guidelines in SuperCoder.com -- just like you did with your ICD-9-CM coding manual -- to locate the appropriate ICD-9-CM code using a key word. Start with the Alphabetic Index and search by the noun’s first letter. For instance, documentation indicates a patient has late effects of an ankle sprain. You look up late/effects/sprain and find 905.7. You click on the code to verify your selection in the Tabular List – just like ICD-9-CM Official Coding and Reporting Guidelines teach you.
Speed tip: For neoplasm and hypertension, you can skip step 1 and go straight to the Neoplasm Table and Hypertension Table located under the Alphabetic Index. Similarly you can search for CPT and HCPCS code

From SuperCoder's Home page, check the type of code you want to find. Selecting CPT, ICD-9, or HCPCS rather than the All box will make the search faster.
On other SuperCoder search pages, pick the codeset you’re looking for from the drop down menu.

You can customize your search to cut down on page clicks. SuperCoder search is set up to show a code’s full hierarchy, which allows you to see all codes in a given family. The full view prevents you from accidently choosing an incorrect code because you didn't see all possible codes. You see codes that might be more appropriate that you may not have otherwise considered. Speed tip: If you prefer to keep your search within the Details view, you can skip the hierarchy view and go directly from locating a searched term to the code's details page. Choose this option under Custom Search from SuperCoder's Main Menu

Go to the ICD-9 Index, select S. From the alphabetic index, go to "Sy". Scroll down to locate "Symptoms". Click on the + sign to open the associated terms. In the list, you'll see "abdomen NEC." Click on the red number 789.9 to see the code’s definition. If you have your custom search set on Details, you'll be taken directly to the code's detail page where you can view related Coding Institute Specialty Alert articles, the code's chapter guidelines, and more. If your search is set on Listings, clicking on 789.9 will take you to the code's hierarchal page, which will show you the code's subcategory and family codes.

A red dot indicates the code is new for that year.

From SuperCoder’s main menu, roll over Coding Community and from the drop down menu, select Forum. In the gray box, click on “Add New”, which will lead to a new page. Fill in the Topic title, enter your question in the middle box, select your specialty from the "Choose a forum" drop down menu, and click the blue “Send Post” button. SuperCoder’s CPC-certified staff will answer your query within 24 hours M-F 9-5 Eastern Standard Time. To view your answer, go back to the Forum list. Under the gray box, find your title and click on it. Scroll down to see the expert answer. Can’t find your title? Enter the key words in the Search box located on the right hand side of the screen. All posts on that topic will appear for you to select your title.

From a four-digit code's hierarchical view, click on the "+" sign to open the fifth digit code's in that subcategory.

Want to stay in a code's detail view and go up or down a code or two? On the top right hand code detail's box, look for your current code in blue sandwiched between two carats: << 52332 >>. Click the left arrow to go up a code and the right arrow to go down a code. To make navigating between screens even easier, look for the "Back" link at the bottom of code hierarchical and details pages to return to the previous page without scrolling back to the top of the page.

An MUE is a medically unlikely edit. Medicare places quantity limits on some CPT and HCPCS codes. You can find the frequency edit under a code’s Physician Fee Schedule MUE row. Look in the Global & Other Info under the final line.

SuperCoder's 2011 Physician Fee Schedule contains information from the Medicare Physician Fee Schedule and the Clinical Lab Fee Schedule. If you are getting 0 values for a pathology code (80047-89398), you need to instead enter the code in the Path Lab Fee Schedule window (http://www.supercoder.com/coders-toolkit/fee-schedule/)

SuperCoder's Fee Schedule lets you check Medicare allowed modifiers, such as if 69210-50 is a valid entry. To find this information, go to SuperCoder's Fee Schedule, enter the questioned CPT code, and scroll down to the bottom of the results' display to Modifier Guidelines. To see whether Medicare allows the modifier on the code, look under the "Rules" heading and click on the blue text that applies to the modifier you're researching. For modifier 50 with 69210, the verbiage indicates Medicare factored payment for a bilateral service into a single unit of 69210, so you should not report 69210-50.

CMS published the Geographic Price Carrier Indice (GPCI) that determines the carrier specific rates using four decimals for the practice expense instead of three decimals. For example, for carrier 0512 and locality 00 (Mississippi), CMS calculated the practice expense GPCI as 0.9285 (4 decimals) when it should have used 0.929 (3 decimals). CMS has stated that they made a mistake on the table but they are not going to correct it since the published national rates are correct.

SuperCoder.com along with the other commercial fee schedule web-based applications are continuing to show the published amounts. If CMS publishes new locality data, we will update our system.

Medicare has specific names for the contractors that pay the kinds of Medicare claims: Part A (facility), Part B (physician), DME (durable medical equipment), and RHHI (home health). The first three types of claims have been switching from one contractor defined name to a different title, as required by the Medicare Modernization Act of 2003. Therefore, the first three types of Medicare services have both an old transitioning title and a replacement title.

To view Local Coverage Determination (LCD) allowed ICD-9 codes or policy details for a given CPT code, you have to select a Contractor Type from SuperCoder's LCD page. Select the type of contractor based on the coding you're doing.
Physician Coders: If you're researching the local coverage determination (LCD) policy for submitting a Part B claim, you should select either Carrier or MAC - Part B. MAC (Medicare Administrative Contractor) Part B contractors are replacing Carrier (Part B) contractors. If your Medicare carrier has not made a switch, stick with Carrier. If your Carrier has transitioned to a MAC Part B contractor, select MAC - Part B.
Facility Coders: When looking for an LCD to file a Part A claim, select either Fiscal Intermediary (FI) or MAC - Part A. MAC Part A contractors are replacing Fiscal Intermediary (FI) contractors. If your FI contractor has not made a switch, stick with FI. If your FI contractor has transitioned to a MAC Part A contractor, select MAC - Part A.
Equipment Coders: If you're looking up a policy for durable medical equipment (DME, reuseable medical equipment ordered by a physician or other allowed nonphysician provider for use in the home sold through a vendor that has a DME license and paid for under both Medicare Part A and Part B under home health services), select one of the DME types:

• DMERC: If you want the durable medical equipment policy that a private company that contracts with Medicare has to pay bills for that DME, select DMERC (Durable Medical Equipment Regional Carrier).
• DME PSC or DME MAC: Policies that fall under Durable Medical Equipment Program Safeguard Contractors (PSC) will move to the DME Medicare Administrative Contractors (DME MACs). If your DME PSC contractor has not made the transition to a DME MAC, select DME PSC. If your DME PSC has made this transition, select DME MAC.

• International Classification of Diseases ICD-9 Volume I - Tabular listing
• International Classification of Diseases ICD-9 Volume II - Index to Diseases
• Current Procedural Terminology CPT
• CPT Modifiers
• Healthcare Common Procedure Coding System HCPCS Level II
• HCPCS Level II Modifiers
• All medical specialties except Anesthesia
• NCD/LCD Coverage
• Medicare contractors by state
• NCCI Bundling/Unbundling Edits
• National Physician Fee Schedule - Relative Value Units, Global Surgery

There are 4 different levels of error messages that the coder should be aware of. You should fix the critical and high errors. Medium and low error changes are up to the coder’s discretion.

Due to the requirements of our claim scrubber, no trial period is allowed.

You may receive a refund but the $20 processing fee is nonrefundable. In other words, we will refund your account for the cost of the scrubber minus $20.

SuperScrubber for Physicians provides short-term demographic storage but not long-term storage of results. Patient information is stored between error reports. You can fix a claim after viewing the error messages without reentering patient and encounter data. Once you exit the claim, the data must be reenetered.

The SuperScrubber real-time individual claim scrubber tools do not allow printing. For copies of your errors and storage, try SuperScrubber for Batches (coming in March).

To check the claim for Medicare LCD ICD-9 allowed codes, you must select your contractor or carrier number. If you don’t know your contractor’s number, click on the blue Contractor letters and select the contractor name from the pop-up list.

While SuperScrubber for Batches will improve your claim acceptance rate, it will not completely eliminate all your denials. A full solution requires a scrubber that can have a customized rule set that takes the knowledge of the billing company or medical practices and codifies it so that it can be applied to every claim before submission.

To ensure complete HIPAA compliance, no claim information is stored on the site. The scrub report is instantly available after uploading the file. That output report can be saved for future reference. When you leave this screen, the error report will no longer be available.

• International Classification of Diseases ICD-9 Volume I - Tabular listing
• International Classification of Diseases ICD-9 Volume II - Index to Diseases
• Current Procedural Terminology CPT
• CPT Modifiers
• Healthcare Common Procedure Coding System HCPCS Level II
• HCPCS Level II Modifiers
• All medical specialties except Anesthesia
• NCD/LCD Coverage
• Medicare contractors by state
• NCCI Bundling/Unbundling Edits
• National Physician Fee Schedule - Relative Value Units, Global Surgery

There are 4 different levels of error messages that the coder can choose to correct, use, or ignore.

Due to the requirements of our SuperScrubber for Batch Processing, no trial period is allowed.

You may receive a refund but the $20 processing fee is nonrefundable. In other words, we will refund your account for the cost of the scrubber minus $20.

You may save the output of the error report.

While SuperScrubber for Batch Processing will improve your claim acceptance rate, it will not completely eliminate all your denials. A full solution requires a scrubber that can have a customized rule set that takes the knowledge of the billing company or medical practices and codifies it so that it can be applied to every claim before submission.

XML and CVS.

Please refer to the Instructional Notes in the “SuperScrubber for Batch Processing” Tool to access the file formats. You can add your data in the editable formats and create your own CSV or XML input file.

For XML, list the modifier above the associated procedure code in the format, in every claim line. For CSV format, there are 10 CPT / HCPCS fields and 10 Modifier (Mod1, Mod2….) fields in the sample form. You need to enter a modifier in a Mod. Field that corresponds to the same-numbered CPT/HCPCS field. For example, let’s assume that one single claim has two different CPT - A & B. and you want to associate modifier 50 with A & 25 with B. Now enter CPT A in CPT/HCPCS1 field and CPT B in CPT / HCPCS2. Then, enter modifier 50 in Mod1 field (as that modifier corresponds to the CPT1) and similarly enter modifier 25 in Mod2 field (as that modifier corresponds to the CPT1). Leave the corresponding modifier field blank, when there’s no modifier to be associated to a particular CPT / HCPCS.

Max. Number of claims in a single file or batch – 250. On a single claim – 4 diagnoses and 10 CPT or HCPCS codes.

The input date should be in “mm-dd-yyyy” format. You must use either “-“(hyphen) or “/” (slash) in the date. [E.g. – 10th March, 2011 should be entered as, either 03-10-2011 or 03/10/2011]

Please refer to the Instructional Notes in the “SuperScrubber for Batch Processing” Tool for each type of file you want to use.

Please refer to the Instructional Notes in the “SuperScrubber for Batch Processing” Tool for each type of file you want to use. Every instructional note document enlists the State’s abbreviated terms and also the Contractor IDs, for your reference.

The coder views the error report and makes any adjustments. The biller can then take the CSV or XML adjusted items and incorporate them into the billing software. Watch for billing software coming to SuperCoder later this year.

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The sections listed represent: OPPS Freestanding: If you are in a freestanding ASC (meaning one not owned or partially owned by a hospital), the facility portion (or the center’s portion) of the procedure is paid under the Outpatient Prospective Payment System (OPPS). MPFS Physician: For all ASCs, the professional portion (or the physician portion) of the procedure is paid to the physician under the Medicare Physician Fee Schedule (MPFS). MPFS Facility RVUs are used to calculate the reimbursement due to the physician under Part B for the professional services. APC Hospital Based: ASCs that are partially or fully owned by a hospital, report the facility cost using an Ambulatory Payment Classification (APC).

Facility RVUs: In an ASC, the professional portion (or the physician portion) of the procedure is paid to the physician under the Medicare Physician Fee Schedule (MPFS) using the facility RVUs. These do not include costs associated with the facility, which are charged separately to the Fiscal Intermediary (Part A). MPFS Facility RVUs are used to calculate the reimbursement due to the physician under Part B for the professional services provided in a facility setting. Nonfacility RVUs: The professional portion (or the physician portion) of a procedure provided in an office or other nonfacility setting is paid under the Medicare Physician Fee Schedule (MPFS). Nonfacility RVUs are used to calculate the reimbursement due to the physician under Part B provided in a nonfacility setting, which accounts for the physician’s added costs of rent, staff, etc.

This list of codes details device codes (HCPCS C codes) that per CMS require modifier FB or modifier FC on the ASC procedure code when the device is furnished at no cost or with full or partial credit. These C codes have no ASC payment assigned (Packaged service/item; no separate payment made), and also have no APC group assigned. These C codes are used "in pairs" with certain CPT / HCPCS codes (under ASC list ), when devices are implanted during surgery. The FB /FC modifier is then required to be appended to that CPT code .

Description: Item Provided Without Cost to Provider, Supplier or Practitioner or a credit was received that covers the cost of the replaced device. Required for Claims: ASC and ED Claims subject to the Outpatient Prospective Payment System (OPPS) Coding Guidelines: 1) Modifier FB is used only when the manufacturer provides the item without cost or the ASC receives a full credit for the cost of the item. 2) Modifier FB is always attached to the surgical procedure code, not the device code. 3) Modifier FB should not be used when the ASC/ED receives only a partial credit toward the cost of the item . THE CENTER/HOSPITAL MUST LOOK AT THE COST OF THE ITEM—NOT THE ASC's/HOSPITAL'S CHARGE FOR THE ITEM – to determine if full credit was received. General Guidelines: Condition codes 49 & 50 are utilized to describe an item that is provided without cost to a provider, supplier, or practitioner for use of items that are under warranty or defective: 49: Product Replacement within Product Life cycle 50: Product Replacement of a Known Recall of a Product Source: Coding Alert

If the ASC receives a partial credit of 50 percent or more of the cost of a specified replacement device due to warranty, recall, or field action, the ASC is required to include modifier FC (Partial credit received for replaced device) on the procedure code if the procedure is on the list of specified procedures to which the FC reduction applies. Medicare contractors pay ASCs a reduced amount for the specified procedures billed with modifier FC to account for the lower cost to the facility to furnish the procedure. Source: CMS

Yes, the Outpatient Facility Coder on the CCI Centric page checks your code combination against the OPPS CCI that all ASCs must follow. The values are ordered in descending value order based on whether you select that the procedure has been performed in the ASC (F) or in the office exam room (NF).

Anesthesia Coder includes numerous features all fully integrated in your CPT® code search including:

• ASA CROSSWALK®
• ASA Reverse CROSSWALK®
• Relative Value Guide®
• adjustable unit-time and day calculator
• annual subscription to Anesthesia Coding Alert with articles added monthly
• complete past archives of Anesthesia Coding Alert.

The geometric mean length of stay or (GMLOS) is the national mean length of stay for each diagnostic related grouper (DRG) as determined and published by CMS. The arithmetic mean length of stay (ALOS) is the average length of stay experienced by a patient within a chosen DRG. The geometric mean reduces the effect of very high or low values, which might bias the mean if a straight average (arithmetic mean) is used. Hospitals can use GMLOS and ALOS to analyze reimbursement impacting areas. For instance, a hospital analyst could collect their hospital’s ALOS for hospital inpatients in a particular DRG admitted on a particular day of the week to the GMLOS. Variations in the length of stay relative to the day of the week that a patient was admitted can identify days that the hospital is receiving less reimbursement for stays that go over the GMLOS. The analyst can then look for possible patterns or downfalls (for instance patients admitted on Friday have a longer LOS due to lack of testing over the weekend). In addition, patient charts can be identified that have longer GMLOS for a DRG to see if conditions were missed that would equate to a higher reimbursing DRG.