Medicare Reference Guide

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The Medicare Quick Reference Guide is an important online tool for ophthalmologists and optometrists to use when referencing the ever-changing Medicare technical edits. This easy-to-use guide utilizes the most current digital CMS data files, updated quarterly, to ensure the accuracy of the information provided. It also incorporates historical CMS files going back several years and every entry is accompanied by explanatory notes, which are easy to use, even for beginners.

What’s Included

CPT Codes – The universe of all codes.

Assistant Surgeon Coverage – Eligible procedures for an assistant surgeon.

Bilateral Payment Indicators – Identifies codes defined by Medicare as unilateral or bilateral.

National Correct Coding Initiative (NCCI) edits (bundles) that identify codes that are mutually exclusive and cannot be billed together.

Diagnostic Test Supervision – Identifies Medicare’s supervision requirements for diagnostic tests.

Global Periods for Surgery – Postoperative intervals (days) for all surgical procedures.

Medically Unlikely Edit (MUE) – a unit of service (UOS) edit for services rendered by a single provider to a single beneficiary on the same date of service. The ideal MUE is the maximum UOS that would be reported for a CPT code.

Multiple Procedure Payment Indicators – Identifies codes subject to payment reductions under the multiple procedure rule.

RVUs – Relative value units for each CPT code for non-facility and facility settings.

Access to the Medicare Quick Reference Guide is available for the yearly membership price of $399.99.

How to Use This Guide

Medicare-Quick-Reference-Guide-Example

To access the Medicare Quick Reference Guide, you will need to log into your account on Corcoran’s website at corcoranccg.com. Once logged in, click on the link to the guide under the “resources” tab at the top of the page.

To begin using the guide, enter the date of service for the code you wish to search. Next, enter the CPT code in the “code 1” field then click “search” with your mouse.

When searching for coding edits, enter the two codes in question.  If both codes are displayed in green, bill both; no edit applies. However, if one code is displayed in red, a ‘bundle’ or ‘mutually exclusive’ coding edit is in place.

If you scroll down the screen, there's additional information from several different CMS publications that have been gathered for your reference. The displayed information is for the green highlighted code only and includes:

  • Test modifiers when applicable.
  • Medically unlikely edits (MUEs).
  • Post-op intervals and days.
  • Relative value units for non-facility and facility settings (they are side-by-side on the screen).
  • Supervision requirements.
  • Assistant surgeon applicability or limitations.
  • Bilateral surgery indicators.
  • Multiple surgery indicators.
  • The complete list of National Correct Coding Initiative edits that apply for the code you entered.
  • A short description of the applicable CPT code for quick reference.

For additional information on each data set, simply click the question mark icon next to the section title.

Do not use this listing to choose a CPT code to describe services. Refer to your CPT book.

To start over and perform a new search, simply hit the “reset” button.

When entering diagnostic test codes, the information provides a detailed breakdown for the professional and technical components as well as the global service. At the bottom of the screen, all the NCCI edits are displayed. The parentheticals zero and one have special meaning as defined by CMS. You can find out what they mean by clicking on the question mark next to the code.

Skilled billers know that using the NCCI edits can be tricky. That’s why the biller is obliged to look up the CPT code twice, once in each direction. Keep in mind, this is not a complete guide on reimbursement. If you have additional questions or need further assistance, please contact us at (800) 399-6565 or send us an email. We're here to help.