The coding tool for professionals


Sep 29, 2001

MedCoder is a Web application developed for use with Microsoft Internet Explorer 5.0+ browser.

Using MedCoder you can search for ICD-9 Vol.1, CPT, and HCPCS codes and you can see codes similar to the way they are displayed in the books. The search process uses keywords from the index and the text of a book and displays the appropriate codes and their descriptions. You can instantly view code specific information, Crosscodes, Medicare's Correct Coding Initiative, LMRP links, HCFA information and Billing information for the selected code. You have instant access to Local Medical Review Policies and the Reviewer function provides auto checking for Age, Sex edits, CCI edits and Medical Necessity.

Using Microsoft Internet Explorer you can easily to go back to a previous screen for the current session. You can copy the information into the clipboard to be pasted into other applications or you can print all the information shown on the screen.

Use of this software is subject to the terms of the license found in the license.txt. You must accept the terms of this license agreement before proceeding.

Contents

Installation Requirements

MedCoder is a Web application and you need to have an Internet connection in order to use the program. MedCoder requires installing the Microsoft Internet Explorer version 5 or never. There are no special hardware requirements except for those that exist for installation of Microsoft Internet Explorer. If you don't have Microsoft Internet Explorer, download and install it free from http://www.microsoft.com/ie/

IMPORTANT: the software will not work with any other browsers or earlier versions of Microsoft Internet Explorer. Please make sure you are using the right browser with full support for Frames and Javascript!

Components

MedCoder includes the following components:

MedCoder is available on a component basis allowing you to customize the application to meet your demands and budget.

Features

Feature Description
Web based Application You do not need to install any software (assuming that you already have Microsoft Internet Explorer browser, which is free and comes preinstalled on the most PC). You don't need to worry about code updates and server database reloading, all updates are instantly available. The software is available for any platform where Microsoft Internet Explorer can be installed.
Search options Search option "Extend" allows you to enter just a beginning of the word, all the codes satisfied to the search criteria will be displayed. The search is looking for codes not only in code descriptions but in the Index of the book as well.
Crosscode Information Crosscode information database compiled from Local Medical Review Policies.
Medicare’s Correct Coding Initiative This feature allows you to see the codes that should not be billed with the selected CPT or HCPCS code. The reason for the unbundling and the modifier allowance, as defined by the Medicare Correct Coding Initiative, is also shown.
Billing Information A geographic practice cost index (GPCI) used for every Medicare payment locality. The GPCIs are applied in the calculation of a fee schedule payment amount by multiplying the RVU for each component times the GPCI for that component. The DMEPOS fee schedule contains the fee schedule amounts, floors, and ceilings for each procedure code subject to the DMEPOS fee schedule payment methodology. As well you can find here more data, for example as Facility / Non-Facility Pricing Amount, the Medicare limiting charge, coverage data, etc.
HCFA Information Alpha-numeric HCPCS procedures have an additional information component, which includes applicable Medicare administrative and coverage data.
Local Medical Review Policies Local Medical Review Policies (LMRPs) are policies with guidelines explaining how claims are paid by the Medicare Program. Each policy contains ICD-9-CM diagnosis codes, addition or deletion of codes, procedure codes, medical necessity information, etc. In the absence of national coverage policy, Medicare carriers are responsible for determining regional coverage based on the advice and input of medical and specialty societies, and a review of current medical practice, clinical data and research studies. Using this feature you can easily check the Medical Necessity or simply view the Policies for selected code.
Reviewer This feature allows to you to enter data from HCFA-1500 form and produce a report based on Age, Sex edits, CCI edits and Medical Necessity data.

Getting Started

Once you have installed the Microsoft Internet Explorer, you can go to http://www.softcorporation.com/products/medcoder and login in to the application.

If you are using the default settings in Microsoft Internet Explorer for the Internet browsing (which mean safe browsing and still functional) you will be able to login and start using the application. If you cannot login, check the browser configuration. It may have settings, which disable JavaScript or per-session cookies. (Per-session cookies are a small amount of information, which is not stored on your computer, but exists in the browser memory and allows making user authentication. Per-session cookies keep your settings, like selected Location and LMRP Provider. These cookies are not stored on your hard drive, so it is absolutely safe to use).

To enable per-session cookies and JavaScript go:

   Microsoft IE Main Menu: Tools, Internet Options...
- select Tab: Security.
- select Icon: Internet.
- select Level: Default level. (It means safe browsing and still functional).

   If you prefer to use Custom level, please select in the security settings:
- option: "Allow per-session cookies (not stored)" as Enable.
- option: "Scripting / Active Scripting" as Enable.

When you are successfully logged in you will see in the main window present help file:

Please note: if you not active during certain time the program logs off automatically, and you have to login again. As well if you login from another computer (or even browser window) with the same name and password, the original session logs off. The advantage of this approach is that you are not limited to work from the only one computer, but from office, hospital, home, etc.

Search for ICD-9, CPT, and HCPCS codes

Getting Code Specific Information

In the Book View click on the code you are interested in. Code specific information displayed at left in the in the Code Information Window.

   ICD-9 Color Legend:
  New Code, identifies new ICD-9 codes.
  Revised Code, identifies ICD-9 codes with revisions.
  Nonspecific Code, identifies ICD-9 codes that are classified as "unspecified" or "other" codes.
  Newborn Diagnosis, identifies ICD-9 codes that are considered a newborn diagnosis.
  Pediatric Diagnosis, identifies ICD-9 codes that are considered a pediatric diagnosis.
  Adult Diagnosis, identifies ICD-9 codes that are considered an adult diagnosis.
  Male Diagnosis, identifies ICD-9 codes that are considered a male diagnosis.
  Female Diagnosis, identifies ICD-9 codes that are considered a female diagnosis.
  Comorbidity or Complication, identifies ICD-9 codes that are related to comorbidity or a complication.
  Not a Primary Diagnosis, identifies ICD-9 codes that do not report primary diagnoses and are never used alone. Known as "manifestations" these codes should only be listed as secondary diagnoses where appropriate.

   CPT Color Legend:
  New Code, identifies new CPT codes.
  Revised Code, identifies CPT codes with revisions.
  Nonspecific Code, identifies CPT codes that are classified as "unspecified" or "other" codes.
  Add-on with Different Diagnosis, identifies add-on CPT codes for which the diagnosis is different than that for the principal procedure.
  Surgical Procedure Only, identifies CPT codes that include the surgical procedure only. Associated pre- and postoperative services are not included.
  Modifier –51 Exempt, identifies CPT codes for which modifier -51 is exempt.
  Add-on Code, identifies add-on (subsidiary) CPT codes.

   HCPCS Color Legend:
  New Code, identifies new HCPCS codes.
  Revised Code, identifies HCPCS codes with revisions.
  Carrier Discretion, identifies HCPCS codes that require carrier discretion. Contact your carrier for specific coverage information for these codes.
  Special Coverage Instructions, identifies HCPCS codes for which special coverage instructions apply. See the HCFA Information for selected code.
  Not Covered By or Valid for Medicare, identifies HCPCS codes that are not covered by or valid for Medicare. See the HCFA Information for selected code.
  Quantity Alert, identifies HCPCS codes that that have associated with them amount.

   Crosscodes, HCFA, CCI, Billing Information:       To see the list of Crosscodes, HCFA, CCI, Billing Information or Search LMRP for selected code click on button.

Navigating in the Book and Book Directory

Double click on the Book Selector tab: Either ICD-9 (for ICD-9 Vol. 1), CPT, or HCPCS. You will see the Book Directory of selected code set in the main window. Click on the code of selected chapter to see the Book View. Book View is a collection of the codes displayed in the main window similar to the way they are appeared in the book.
In the top of the main window located Navigation Bar with following options:
- Prompt: click to scroll to the selected code (or the prompt position).
- Page Up: click to go to the previous page.
- Page Down: click to go to the next page.
- Directory: click to see the book directory.
Click on the blue code in the beginning of the line to see the code specific information. Light blue codes in the text of a book are the links to those codes. Click on it to see the Book View for the code. The prompt shows your current position in the book.

Billing Information

Click on the Billing Information in the Code Information Window to see the Billing Information. It includes for each procedure code, modifier code (where applicable):
- Locality-specific physician fee schedule payment amounts for services covered by the Medicare Physician Fee Schedule.
- DMEPOS fee schedule containing fee schedule amounts, floors, and ceilings.
- Additional information.

The RVU information is derived from the HCFA National Physician Fee Schedule Relative Value File. MedCoder includes the GPCI data for calculations of Medicare payments based on geographic locality.

The Medicare limiting charge is set by law at 115 percent of the payment amount for the service furnished by the nonparticipating physician. However, the law sets the payment amount for nonparticipating physicians at 95 percent of the payment amount for participating physicians (i.e. the full fee schedule amount). Calculating 95 percent of 115 percent of an amount is equivalent to multiplying the amount by a factor of 1.0925 (or 109.25 percent). Therefore, to calculate the Medicare limiting charge for a physician service for a locality, we multiply the full fee schedule amount by a factor of 1.0925. The result is the Medicare limiting charge for that service for that locality to which the full fee schedule amount applies.

The DMEPOS fee schedule contains fee schedule amounts, floors, and ceilings for each procedure code subject to the DMEPOS fee schedule payment methodology. DMEPOS fee schedule amounts are calculated based on three separate payment methodologies: DME, prosthetic and orthotic, and surgical dressings.

Update Schedule: The fee schedule will be updated on a quarterly basis, with the January 1 implementation date being the primary update. In addition to the January file, updated data will be available in early April, July, and October.

Medicare's Correct Coding Initiative

Click on the CCI Information in the Code Information Window to see the Medicare's Correct Coding Initiative Information. This feature allows seeing the codes that should not be billed with the selected CPT or HCPCS code. It includes for each procedure code (where applicable):
- The reason for the unbundling ('ME' - Mutually Exclusive, 'CC' - Comprehensive and Compound).
- The modifier allowance indicator ('Y' - modifier allowed, 'N' - not allowed).
- Policy.

Update Schedule: The Medicare's Correct Coding Initiative information will be updated on a quarterly basis.

Local Medical Review Policies

Click on the LMRP Crosscodes in the Code Information Window to see the list of codes referred in Local Medical Review Policies for this code. Each code on the list has a link to the policy and an indicator "Y/N".
'Y' - Code supports Medical Necessity or Covered code.
'N' - Code does not support Medical Necessity or Non-covered code.

To see the Policy click button at right.

List of available providers:

Number  Name  State  Region 
00660 Adminastar Federal, Inc KY IV
00630 Adminastar Federal, Inc. IN V
00520 Arkansas BCBS AR VI
00521 Arkansas BCBS NM VI
00522 Arkansas BCBS OK VI
00523 Arkansas BCBS Eastern MO VI
00528 Arkansas BCBS LA VI
00510 BCBS Alabama AL IV
00751 Blue Cross and Blue Shield of Montana MT VIII
00801 Blue Cross and Blue Shield of Western NY Western NY II
00870 Blue Cross and Blue Shield, RI RI I
00650 Blue Cross Blue Shield KS KS/Western MO VII
00655 Blue Cross Blue Shield KS NE VII
00511 Cahaba Government Benefits Admin GA IV
00512 Cahaba Government Benefits Admin MS IV
05130 CIGNA Healthcare, Medicare Administration ID X
05535 Connecticut General Life Ins. Co (CIGNA) NC IV
05440 Connecticut General Life Ins. Co. (CIGNA) TN IV
00803 Empire Medicare Services NY II
00805 Empire Medicare Services NJ II
00590 First Coast Service Options, Inc. FL IV
00591 First Coast Service Options, Inc. CT I
14330 Group Health Inc. Queens, NY II
00865 HGSA Administrators PA III
31140 National Heritage Insurance Company N Calf IX
31146 National Heritage Insurance Company S Calif IX
31142 National Heritage Insurance Company, NE ME I
31143 National Heritage Insurance Company, NE MA I
31144 National Heritage Insurance Company, NE NH I
31145 National Heritage Insurance Company, NE VT I
16360 Nationwide Mutual Ins. Co OH V
16510 Nationwide Mutual Ins. Co WV V
00820 Noridian Mutual Life Insurance Company ND, SD VIII
00821 Noridian Mutual Life Insurance Company AK,AZ,HI,NV,OR,WA  VIII
00824 Noridian Mutual Life Insurance Company CO VIII
00825 Noridian Mutual Life Insurance Company WY VIII
00826 Noridian Mutual Life Insurance Company IA VIII
00880 Palmetto Gov. Benefits Admin SC IV
00910 Regence Blue Cross and Blue Shield of Utah UT VIII
00973 Seguros de Servicio de Salud de Puerto Rico Inc. PR II
00974 Seguros de Servicio de Salud de Puerto Rico Inc. VI II
00900 Trailblazers Health Enterprises TX VI
00901 Trailblazers Health Enterprises MD III
00902 Trailblazers Health Enterprises DE III
00903 Trailblazers Health Enterprises DC III
00904 Trailblazers Health Enterprises VA III
00951 Wisconsin Physicians Service Ins. Co WI V
00952 Wisconsin Physicians Service Ins. Co IL V
00953 Wisconsin Physicians Service Ins. Co MI V
00954 Wisconsin Physicians Services Ins Co MN V

Please contact us before subscribe to certain provider.

Reviewer

Click on the 'Reviewer' tag in the Search Window to see the Reviewer window.

You can add codes to the Reviewer clicking on "Add to Reviewer" tag in Code Specific Information Window, or simply type the codes in the Reviewer. The same rules as for HCFA-1500 apply to the Reviewer. You will need to enter the patient age and date service provided and/or patient sex if you are using age/sex specific codes.
- 'Review' button (on the top right side of main window). Click to process the Review; you will see the Report printed under the form.
- 'Update' button. Click to save manually entered data in the session memory.
- 'Clear' button. Click to clear the Reviewer.

Reviewer produce the Report based on Age, Sex edits, CCI edits and Medical Necessity information from selected LMRP provider.

MedCoder Setup

Click on the Setup tag in the Search Window to see the Setup window.

MedCoder Setup allows selecting the Location for calculating Fee Schedule Amounts and LMRP Provider. Make your settings and click button to save it for current session.

Licensing Terms

Please read the license.txt file and agree to the terms and conditions described in the license before using the software.

How to Contact Us

We value your feedback! Please submit your comments, questions, and suggestions to SoftCorporation LLC. Technical Support Group:  support@softcorporation.com

Visit out Web site at the following URL:  http://www.softcorporation.com


The information in this document is subject to change without notice. SoftCorporation LLC. assumes no responsibility for any errors that may appear in this document.

The software described in this document is furnished under a license and may be used only in accordance with the terms of such license.

Microsoft, Microsoft Internet Explorer are registered trademarks of Microsoft Corporation

CPT codes, descriptions, and modifiers only are Copyright 2000 American Medical Association. All Rights Reserved.

All other trademarks and service marks are the property of their respective companies.

Copyright © 2001 SoftCorporation LLC. All Rights Reserved.

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