Billing and Coding Resources
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This section is designed to provide a compilation of billing and coding resources for infectious diseases (ID) physicians in private practice and academic medicine as well as their practice managers. These resources include information about current payment rates for Evaluation and Management service codes commonly used by ID physicians, ID-specific utilization data, correct coding tools, and how to negotiate infection control contracts with your hospitals.
*Please contact Jason Scull, Program Officer for Clinical Affairs, with billing and coding questions, as well as to propose additional resources that would enhance the value of this page to you and your colleagues.
Important Billing and Coding Updates
ID-Specific Correct Coding Resources *Update*
Inpatient pocket card and outpatient wall poster designed to assist ID practices in choosing the appropriate level E&M code and to provide guidance on billing prolonged services and critical care visit codes. Click here to order hard copies of the coding resources--updated May 2010. (Log-in Required)
Congress Forestalls Deep Physician Payment Cuts But Leaves Consultations Decision in Place*New*
Despite Congressional action that forestalls deep physician payment cuts during the first two months of 2010, some ID practices may still see significant decreases in their reimbursements due to Medicare's decision to eliminate payments for consultation codes. Please go to a Frequently Asked Questions document for help in understanding the new Medicare coding rules. (Log-in Required)
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ID-Specific Billing and Coding Resources
CPT Coding for ID Specialists: How to Avoid Errors
Access IDSA's "Ask the Coder" E-mail Portal and download/order E&M coding resources specific to the practice of infectious diseases. Information about Medicare Improper Payments and the Recover Audit Contractors program also is provided through this page. (Log-in Required)
Medicare Utilization Data for Infectious Diseases Specialists
2008 utilization rates for CPT codes used by ID specialists and other relevant medical specialists are now available. (Log-in Required)
Medicare Adult Immunization Resources
Provides information and resources related to the delivery and administration of Medicare covered vaccines, including billing instructions and reimbursement rates for influenza, pneumococcal, and hepatitis B vaccines.
Outpatient Infusion and Injection Coding and Payment Information
Provides up-to-date information on the way infectious diseases physicians code and the Centers for Medicare and Medicaid Services (CMS) reimburses for office-based infusions and injections. Please click here to learn what IDSA is doing to ensure Medicare beneficiaries' access to home infusion therapies or go to www.opat.com for additional infusion-related information. (Log-in Required)
Infection Control Medical Directors: How to Negotiate Equitable Compensation Rates
Provides information about the Fair Market Value payment methodology governing infection control medical directors payments and how to negotiate equitable hourly payment rates or compensation arrangements with your hospital for these services. (Log-in Required)
A Guide to Physician Payments for Patient Certification/Recertification of Home Care Visits (G0179 & G0180) and Care Plan Oversight (G0181 & G0182)
This summary provides an overview and highlights of billing Medicare for Home Care Certification, Recertification and Care Plan Oversight. (Log-in Required)
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Other Billing and Coding Resources
Recovery Audit Contractors*New*
This resource is designed to help infectious diseases practices understand and navigate Medicare's Recovery Audit Contractors (RAC) claims review process.
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ICD-9 RapidCoder
Valuable resource that offers a web service to quickly look up ICD-9 codes used by infectious diseases specialists, and an Infectious Diseases ICD-9 RapidCoder 8.5"x11" Plastic Card
American Academy of Professional Coders (AAPC)
The AAPC provides education and certification for professional medical coders, including specialty credentials for evaluation and management codes.
International Classification of Diseases, Ninth Revision, Clinical Modification, Sixth Edition (ICD-9-CM)
Updated ICD-9-CM guidelines from the CDC, a conversion table for diagnostic and procedure code changes between 1986 and 2004, and an agenda are available for download. Official version is available on CD-ROM from the Government Printing Office (GPO) at 202-512-1800 or fax: 202-512-2250. The CD-ROM contains the ICD-9-CM classification and coding guidelines.
National Provider Identifier
Beginning March 1, 2008, physicians and their practices must include their National Provider Identifier (NPI) as the primary identifier on all electronic and paper Medicare Fee-for-Service claims. This web page includes important information about the process for obtainining your NPI as well as the Data Dissemination Notice, which requires Medicare to make certain NPI data available to the public.
Physician Fee Schedule Look-up
Medicare site designed to find payment amounts, relative value units, and geographic practice cost indices by a single CPT code, a range and a list of CPT codes.
What to do in the Event of a Payer Audit
Guidance on how to respond to a request for medical records, how to respond to the audit results, and how to appeal results. (Log-in Required)
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