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Some codes define that a service is limited to professionals or limited to other entities such as hospitals or home health agencies. Green, CMA(AAMA), CPC, CPMA, CPC I Coding Principals Correct coding implies the selection is What are we doing? Procedures Why are we doing it? Diagnosis Supported by documentation Supported by documentation Consistent with coding guidelines 1Ģ Coding Principals Reporting Services IS there physician work or practice expense? Can it be supported by an ICD 9 code? Is it independent of other procedures/services? Is there documentation of the service? Billing Rule Not documented means Not done Not documented Not billable Documentation must support type and level of extent of service reported Code Sets Key Code sets HCPCS (includes CPT 4) ICD 9 CM/ICD 10 CM HCPCS d ib h t HCPCS describes what ICD 9 CM describes why 2ģ Who can bill as a Provider? Change have been made throughout the CPT manual to clarify who may provide certain services with the addition of the phrase other qualified healthcare professionals.

1 Coding for the OB/GYN Practice NAMAS 5 th Annual Auditing Conference Atlanta, GA DecemPeggy Y.

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