How do the helpful tools and information provide support when reviewing medical documentation of E/M service visits? Explain how the NCCI edits, Medicare Claims Processing Manual, and CMS provide useful resources, support to the 1995, 1997 Documentation Guidelines, and the CPT manual

Question

What will be an ideal response?

Answer 1

A. CMS collaborates with the National Uniform Claims Committee to maintain and update the UB-04 claim form and the CMS-1500, which should be completed and used when submitting any Medicare or Medicaid claim.
B. CMS manages and provides oversight for Medicare and Medicaid, which has a variety of helpful links and information about E/M guidelines, including the 1995 and 1997 Documentation guidelines, and the "Medicare Claims Processing Manual," which includes extensive guidelines and regulations for the correct reporting of E/M services, NPPs, incident-to services, shared/split visits, the correct use of modifiers, and global periods of surgery.
C. The National Correct Coding Initiative is intended to increase correct coding through the identification of codes that may or may not be utilized together. Known as the NCCI edits, these tools identify medically unlikely edits, or the maximum number of times a specific code may be reported during one unit of service, or episode of care. The NCCI edits also identify the hospital outpatient edits, which include two different resources useful for correct coding. Column 1/Column 2 edits table identifies the codes that may or may not be utilized together, as well as identifying whether a modifier is allowed in a particular situation. The Mutually Exclusive Code edits table identifies E/M service codes that may never be reported together.
D. Ten different regional CMS offices provide oversight and support throughout the country. CMS coding regulation guidelines provide leadership and direction for clinicians, coders, and many others in various aspects of healthcare.