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What is the CMS-1500?
the standard claim form that medical professionals use to report patient care and costs to insurance companies and government agencies (Medicare, Medicaid)
What is a Superbill?
A standard form that medical professionals use which makes it easy for doctors to tell coders all the necessary information about routine patient encounters.
Which codes are found in the ICD-9-CM?
- Diagnosis Codes
- E Codes
- V Codes
Which codes are found in the CPT manual?
- E/M codes (evaluation and management)
- CPT procedure codes
What will you find in the ICD-9-CM?
You'll find the names of over 9,000 diseases, conditions, and symptoms. The three codes that come out of the ICD-9-CM (Diagnosis codes, E-codes, and V-codes) describe everthing about what's wrong with the patient.
What is the Diagnosis Code?
The Diagnosis Code is the most important. It describes the disease,symptom, or condition that the doctor is treating. Most of the codes that make up the ICD-9-CM are diagnosis codes.
How many digits does the diagnosis codes consist of?
Diagnosis codes consist of at least three digits and as many as five. If there are four or five digits in the code, the code will include a decimal point.
What are V-codes?
V-codes describe a reason for an encounter with a health care professional (not necessarily disease-related).
Where are V-codes located?
V-codes are located at the end of the ICD-9-CM, and again in the alphabetical index.
What are E-codes?
E-codes describe both how and where an injury (trauma) happened. Sometimes more than one will apply to the same injury. E-codes have their own seperate index in the ICD-9-CM (at the end of your regular index; located in the Alphabetic Index to External Causes)
All the codes in the CPT manual are for what?
All the codes in the CPT manual are for procedures and services that the doctor or other medical professional provides to the patient. The procedure or service could range from a major surgery or chemotherapy to a throat culture or a well-child checkup. These are the codes that make up most of the CPT manual. They are five digits long with no decimals.
What are E/M codes?
E and M codes are five digits long just like the CPT procedure codes but E/M codes always start with 99. They appear in a special section at the beginning of the CPT manual. The E/M is the initial charge just for face-to-face tiem with the doctor. There are different levels of E/M codes. Remember, insurance companies pay more based on degree of difficulty.
What can you do to support a high level of E/M code on a CMS 1500?
you simply attach the documentation fromthe visit as an explanation. or you can certainly break up the claim and submit it on different forms. They are listed in orderof importance down the line.
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