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.
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/
MedCoder includes the following components:
MedCoder is available on a component basis allowing you to customize the application to meet your demands and budget.
|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.|
Once you have installed the Microsoft Internet Explorer, you can go to http://www.softcorporation.com/products/medcoder and login in to the application.
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.
|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.|
|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.|
|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.|
Navigating in the Book and Book Directory
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
Update Schedule: The Medicare's Correct Coding Initiative information will be updated on a quarterly basis.
Local Medical Review Policies
To see the Policy click button at right.
List of available providers:
|00660||Adminastar Federal, Inc||KY||IV|
|00630||Adminastar Federal, Inc.||IN||V|
|00523||Arkansas BCBS||Eastern MO||VI|
|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|
|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.
Click on the 'Reviewer' tag in the Search Window to see the Reviewer window.
Reviewer produce the Report based on Age, Sex edits, CCI edits and Medical Necessity information from selected LMRP provider.
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.
Please read the license.txt file and agree to the terms and conditions described in the license before using the software.
We value your feedback! Please submit your comments, questions, and suggestions to SoftCorporation LLC. Technical Support Group: firstname.lastname@example.org
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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