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Reimbursement/EHR Articles, Backgrounders, Guidelines and Websites

Electronic Health Records Articles/Resources

PQRI Eligible Professionals 

Eligible Professional HIT Planner  

Medicare Electronic Health Record Incentive Program for Eligible Professionals 

Health Information Technology Update 

Final Meaningful Use Criteria and Comments 

Electronic Health Records Websites

Medical Group  Management Association  

Centers for Medicare & Medicaid Services Electronic Prescribing Incentive Program and e-Prescribing  

E-Prescribing Websites

AOA-Avoiding the Adjustment – 2011 Electronic Prescribing Incentive Program Reminder 

AOA-E-Prescribing Incentive Program – Qualifying and Avoiding the Penalty 

Coding Articles/Resources

OMT Coding Strategies to Boost Your Bottom Line 

The benefits to patients and to your bottom line far outweigh the perceived barriers to making OMT part of your daily practice, both inpatient and outpatient. Subject areas covered: Bundling; therapy vs. Treatment; using -25 vs. -51 Modifiers; capitation; chiropractic associations and appeals.

Last Annual ICD-9 Update Announced 

The last annual update of ICD-9 took effect Oct. 1. This article provides an overview of the new and expanded codes that are included in the update.

ICD-10 – Will You Be Ready?  

Diagnosis coding for physician offices is going to change.  Dos will be required to use the ICD-10 code set beginning October 1, 2013. This article describes how this change will affect affect diagnosis and inpatient procedures coding.

The ICD-10 Transition – An Introduction

On October 1, 2013, the ICD-9 code sets used to report medical diagnoses and inpatient procedures will be replaced by ICD-10 code sets. To accommodate the ICD-10 code structure, the transaction standards used for electronic health care claims, Version 4010/4010A, must be upgraded to Version 5010 by January 1, 2012. This fact sheet provides background on the ICD-10 transition, general guidance on how to prepare for it, and resources for more information.

New Health Care Electronic Transactions Standards - Version 5010 Basics Fact Sheet 

This fact sheet provides basic information about the revised set of HIPAA transaction standards for health care electronic transaction that were adopted to replace the current Version 4010/4010A standards. Every standard has been updated, from claims to eligibility to referral authorizations.

Coding Guidelines

ICD-10-CM Official Guidelines for Coding and Reporting 

 The Centers for Medicare and Medicaid Services and the National Center for Health Statistics, two departments within the U.S. Federal Government’s Department of Health and Human Services, provide the official guidelines for coding and reporting using the International Classification of Diseases, 10th Revision, Clinical Modification (ICD-10-CM). These guidelines should be used as a companion document to the official version of the ICD-10-CM as published on the NCHS website.

Coding Websites

CMS ICD-9 Provider & Diagnostic Codes 

Diagnostic and Procedure Codes: Abbreviated and Full Code Titles.

Provides downloadable files of diagnosis and procedure codes and their full and abbreviated titles.

CMS ICD-9-CM Addenda, Conversion Table and Guidelines  

The annual update to ICD-9-CM is provided as addenda changes to the index and tabular list of ICD-9-CM. In the index, additions are marked with bold and underlining, revisions are marked in bold, underlining and italic, while deletions are marked with bold and strikeout.

Are You Prepared for ICD-10 Webpage - AOA 

CMS ICD-10 Website  

CMS Documentation Guidelines for Evaluation and Management (E/M) Services 

Offers E/M services information and resources.  Downloads include “Evaluation and Management Services Guide,” “1997 Documentation Guidelines for Evaluation and Management Services: and 1995 Documentation Guidelines for Evaluation and Management Services.”

International Classification of Diseases 

The ICD is the international standard diagnostic classification for all general epidemiological, many health management purposes and clinical use. These include the analysis of the general health situation of population groups and monitoring of their incidence and prevalence of disease and other health problems. This site, sponsored by the World Health Organization, provides a range of information about ICD, from the history of ICD to ICD training to the “ICD-10 2nd Edition Volume 2 Instruction Manual.”

CMS HCPCS Page 

The site provides downloadable files of helpful documents related to the HCPCS coding system.

The Healthcare Common Procedure Coding Systems (HCPS) is divided into two principal subsystems, referred to Level 1 and Level 2.

Level 1 of the HCPCS is comprised of Current Procedural Terminology (CPT-4), a numeric coding system maintained by the American Medical Association (AMA). The CPT-4 is a uniform coding system consisting of descriptive terms and identifying codes that are used primarily to identify medical services and procedures furnished by physicians and other health care professionals for which they in turn use to bill public or private health insurance programs.

Level 2 of the coding system classifies similar products that are medical in nature into categories for the purpose of efficient claims processing. Products are classified based on similarities in function and whether the products exhibit significant therapeutic distinctions from other products. These include ambulance services and durable medical equipment, prosthetics, orthotics and supplies when used outside a physician’s office.

CMS Medicare Learning Network Educational Web Guides Overview 

Provides information on Evaluation and Management (E/M) services, guided pathways to resources and topics of interest, lists of health care management products as well as east-to-understand billing and coding products.