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April 24, 2015 - Revised: 10.15.19

Coding Questions: Where to Go for Help

CGS has seen a significant increase in inquiries about “what code to bill” for services they provided.  CGS does not pre-select codes for providers; in fact, guidelines from the Centers for Medicare & Medicaid Services (CMS) prohibit Medicare Administrative Contractors (MACs), including CGS, from selecting a code or modifier for you.  However, we are happy to provide you with guidelines and resources to assist you in making informed decisions and selecting the code (and modifier, if appropriate) that accurately represents the service provided. 

CMS guidelines specify that “providers are responsible for determining the correct diagnostic and procedural coding for the services they furnish to Medicare beneficiaries.” The entities that have responsibility for the coding sets are good resources:

Code Set

Description

Resource

Current Procedural Terminology (CPT) codes

CPT codes are proprietary to the American Medical Association (AMA). The AMA offers CPT Information Services (CPT-IS). The AMA offers a variety of coding resources.

American Medical AssociationExternal Website

The American Hospital Association’s Coding Clinic responds to questions related to CPT codes for hospital providers.

AHA Central OfficeExternal Website

ICD-9-CM and
ICD-10-CM

Questions regarding ICD-9-CM and ICD-10-CM codes are addressed in the American Hospital Association’s Coding Clinic.

AHA Central OfficeExternal Website

Level II Healthcare Common Procedure Coding System (HCPCS) codes related to durable medical equipment or prosthetics, orthotics, and supplies (DMEPOS)

Questions about HCPCS codes for DMEPOS are answered by the Pricing, Data Analysis and Coding (PDAC) Contractor

Pricing, Data Analysis and Coding (PDAC) ContractorExternal Website

Level II HCPCS codes, specifically A-codes for ambulance service and radiopharmaceuticals, C-codes, G-codes, J-codes, and Q-codes (except Q0136 through Q0181)

The American Hospital Association’s Coding Clinic for HCPCS responds to questions related to these Level II HCPCS codes for hospitals, physicians, and other health professionals who bill Medicare.

AHA Central OfficeExternal Website

Additional information is available at the HCPCS - General InformationExternal Website section of the CMS website

Reference:

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