The Revised CMS-1500 Form

The Revised CMS-1500 Form

ATCMS SeminarMarch 30, 2014

By Ling Zheng, L.Ac.

The Revised CMS-1500 Form General information regarding the

revised CMS-1500 form What are the differences between

the CMS-1500 form (02/12) and the CMS-1500 form (08/05)

How to fill out the new form How to get the new form and the

online information

General Information

The Office of Management and Budgets (OMB) has approved a revised CMS-1500 health insurance claim form (version 02/12) to replace the current form (version 08/05). Healthcare providers are required to use the revised CMS-1500 form for their medical reimbursement since April 1, 2014

How to fill out the new form

What are differences between the revised form and the original one

How to fill out the changed items on the revised claim form


Add a QR Codes symbol to the top, left hand margin of the claim form


Item 1:

Minor changes to the wording of payer ID number requirements


Item 8: Changed to “RESERVED FOR NUCC

USE”, Removed “PATIENT STATUS” from

the original formDescription: This field is reserved for

NUCC use


Item 9b and 9c:Replaced with “RESERVED FOR NUCC

USE”Removed “EMPLOYER’S NAME OR

SCHOOL NAME” from the original formDescription: The field is reserved for

NUCC (National Uniform Claim Committee) use


Item 10d:Changed to “CLAIM CODES

(Designated by NUCC)”Instruction: When applicable,

use to report appropriate claim codes designated by the NUCC


For the workers’ Compensation claims, condition Codes are required when submitting a bill that is a duplicate or an appeal. (Original Reference Number must be entered in Box 22 for these conditions). Note: Do not use Condition Codes when submitting a revised or corrected bill.


Original claim: NoneDuplicate claim: W2Appeal-Level 1: W3Appeal-Level 2: W4Appeal-Level 3: W5


Item 11b:Changed to “OTHER CLAIM ID

(Designated by NUCC)”Instruction: For workers’

compensation or property & casualty (such as No-Fault), should enter qualifier “Y4” and claim number assigned by the payer


Item 14:Minor changes to layout of fieldInstruction: Enter the first date of the

present illness, injury, or pregnancy (LMP), then enter the following applicable qualifier

Onset of current symptoms or illness: 431Last menstrual period: 484


Item 15:Changed to “OTHER DATE”Removed “IF PATIENT HAS HAD SAME OR

SIMILAR ILLNESS, GIVE FIRST DATE” from the original form

Instruction: May enter the qualifier “454”, then enter the date of the initial treatment


Item 17:Added a field to report a qualifier to

identify which provider is being reportedInstruction: Enter the name of provider

who referred or ordered the service on the claim, then enter the applicable qualifier to identify which provider is being reported


DN Referring providerDK Ordering providerDQ Supervising provider


Item 19:Replaced with “ADDITIONAL CLAIM

INFORMATION (Designated by NUCC)”

Removed “RESERVED FOR LOCAL USE” from the original form

Instruction: Don’t need to fill it unless it is required


Item 21:Added eight additional lines for

diagnosis of illness/injuryInstruction: Enter the applicable ICD indicator to

identify which version of ICD codes is being reported, in the upper right-hand portion of the field


ICD Indicator:

9 ICD-9-CM 0 ICD-10-CM


Enter the ICD codes to identify the patient’s diagnosis and/or condition. List no more than 12 ICD-9-CM or ICD-10-CM codes relating to the service(s) on the claim


Item 24E: DIAGNOSIS POINTERInstruction: Enter the diagnosis code reference

letter (such as AB…) as shown in item 21 to relate the date of services and the procedures performed.

The field allows for the entry of up to 4 characters in unshaded area


Item 30:Replaced with “Rsvd for NUCC Use”Removed “BALANCE DUE” from the

original formDescription: This field is reserved for

NUCC use

How to get the new claim form

How to get the CMS-1500-Form (version 02/12)?

May order the forms at:www.medicalartspress.com

Online reference information

Reference Information: Please read <<1500 Health

Insurance Claim Form Reference Instruction Manual for Form Version 02/12>> provided by National Uniform Claim Committee (NUCC)

Online reference information

The online information is available at:

http://www.findacode.com/cms1500-claim-form/instructions-02-12/1500_claim_form_instruction_manual_2012_02.pdf

The Revised CMS-1500 Form

Thank you !

ICD-10-Codes Commonly Used By Acupuncturists

ATCMS SeminarMarch 30, 2014

By Ling Zheng, L.Ac.

Highlights of the talk General information regarding ICD-10-

Coding system To introduce <<List of ICD-10 Codes

Commonly Used by Acupuncturists>> Acupuncture coverage policy provided

by different major insurance companies

Online information regarding ICD-10-Codes

General Information

Brief introduction of ICD-10-CM ICD-10-CM Coding system What are differences between

ICD-10-CM and ICD-9-CM The deadline for using the ICD-

10-Codes

Brief Introduce ICD-10-CM

ICD Codes: International Classification of Diseases (ICD) codes is a coding system to indicate diagnoses, symptoms, injuries, and other conditions. This coding system is developed and published by WHO.

ICD-10: is the 10th revision of ICD coding system developed by WHO on January 1, 1999

Brief Introduce ICD-10-CM

ICD-10-CM: Based on ICD-10 coding system published by WHO, U.S. Government (the National Center for Health Statistics, NCHS) published the ICD-10-CM (International Classification of Diseases, 10th revision, Clinical Modification) on January 1, 2014.

ICD-10-CM Coding System ICD-10-CM is an alphanumeric

classification system. It consists of up to 7 characters.

The first character is a letter followed by numbers or alpha characters.

The injury-ICD-code should be added an appropriate 7th alpha character (such as A, D, or S) according to the different statuses

What are differences between ICD-10-CM and ICD-9-CM

ICD-10-CM codes consist of up to 7 alphanumeric characters, and ICD-9-CM codes consist of up to 5 alphanumeric characters only

ICD-10-CM contains subcategories codes to indicated conditions on right side or left side, and upper or lower extremity

What are differences between ICD-10-CM and ICD-9-CM

Expanded injury codes Add the 7th alpha character on injury

codes to describe patients’ status Add the external cause codes to

describe the cause, the intend, the place of injury occurrence

When Should I Use ICD-10-CM

Since October 1, 2014, healthcare providers are required to use ICD-10-CM codes for medical reimbursements

ICD-10-CM Codes Commonly Used by Acupuncturists

Why dose ATCMS provide the <<List of ICD-10-Codes Commonly Used by Acupuncturists>> to our AOM colleagues?

To help AOM practitioners using the new ICD codes easily and correctly, ATCMS offer this reference coding material to our colleagues

ICD-10-CM Codes Commonly Used by Acupuncturists

The reference coding material has listed about 400 ICD-10-CM codes commonly used by acupuncture practitioners

Considering the purpose of acupuncture reimbursements, the listed codes have been divided to the following three parts: (1) Pain and related conditions; (2) Injuries; and (3) Other conditions

Part I: Pain and the Related Conditions

Pain management is the most common case treated at acupuncture clinic

In general, some major insurance companies consider acupuncture as a medically necessary procedure for treating pain and the related conditions, such as osteoarthritis, migraine, neck pain or lower back pain

Part II: Injuries

Injuries is common cases treated at acupuncture clinic also

These ICD codes are used for acupuncture reimbursements on No-Fault or workers’ compensation cases

Some major insurance policies also cover acupuncture for injuries

Part II: Injuries

All injury codes should be 7-character-codes

The 7th character of injury codes should be a letter “A”, “D”, or “S”, according to the following different statuses:

Part II: Injuries For the status of initial encounter, the

7th character of the code should be “A”For Example: Strain of unspecified muscle and

tendon at right leg level with the status of initial encounter, the ICD code should be “S86.911A” (S86.911 plus A)

Part II: Injuries

For the status of subsequent encounter, the 7th character of the code should be “D”

For Example: Strain of unspecified muscle and tendon

at right leg level with the status of subsequent encounter, the ICD code should be “S86.911D” (S86.911 plus D)

Part II: Injuries

For the status of sequel, the 7th character of the code should be “S”

For Example: Strain of unspecified muscle and

tendon at right leg level with the status of sequel, the ICD code should be “S86.911S” (S86.911 plus S)

Part II: Injuries

If the injury code with fewer than six characters, it requires the placeholder “X” to fill the missing between the code and the above 7th alpha character

Part II: Injuries

Example-1: Sprain of unspecified site of right

knee with the status of initial encounter, the ICD code should be “S83.91XA” (to fill X between 5-character-code S83.91 and the 7th alpha character A)

Part II: Injuries

Example-1: Sprain of muscle, fascia and

tendon at neck with the status of subsequent encounter, the ICD code should be “S16.1XXD” (to fill XX between 4-character-code S16.1 and the 7th alpha character D)

External Cause Codes

External cause codes: describe the cause, the intent, the place of occurrence, and if applicable, the activity of the patient at the time of the event, and the patient’s status, for all injuries

These codes may be used with the injury codes


External cause codes can be used as many as necessary to full explain each cause

They should be used with the related injury codes, and can never be a principal (first listed) diagnosis


There is no national requirement for mandatory ICD-10-CM external cause code reporting

However, it may be helpful for the insurance reimbursement on the WC or NF cases

External Cause Codes External cause codes should be 7-

character-codes The 7th character of these codes

should be an alpha character (such as “A”, “D”, or “S”) according to the different statuses

May need to add the placeholder “X” to fill the missing as the injury codes

Part III: Other Conditions

Some major insurance policies consider acupuncture as a medically necessary procedure for the following conditions:

R11.2 Post-operative or chemotherapy-induced nausea and vomiting

O21.9 Vomiting of pregnancy, unspecified

Part III: Other Conditions However, other ICD codes listed on this

part may NOT be considered as a suitable condition for acupuncture treatment, according to the current policies provided by most major insurance companies

Try to avoid using these codes unless confirming they are covered conditions

Acupuncture Coverage Policy Provided by Some Major Ins. Co.

Empire Blue Cross & Blue Should

Cigna Aetna

Acupuncture Coverage Policy Provided by Some Major Ins. Co.

Each insurance company may have different plans which provide different acupuncture coverage policies

Strongly urge acupuncturists to verify every individual patient’s acupuncture benefits before accepting his/her insurance plan

Online Information for ICD-10-CM Codes

Please visit:

www.icd10data.com

For more ICD codes information by entering the diagnosis or symptoms

ICD-10-CM Codes

Question &

Discussing

ICD-10-CM Codes

Thanks!

The Revised CMS-1500 Form

Documents

Transcript of The Revised CMS-1500 Form