May 1, 2024
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Essential Medical Coding Tools for Professionals

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By Janine Mothershed

Comprehensive Guide to Essential Medical Coding Tools

In the intricate world of medical coding, accuracy and efficiency are paramount. With the ever-evolving healthcare landscape and the complexities of coding guidelines, having the right medical coding tools at your disposal is crucial for ensuring precise code assignment. Whether you’re a seasoned professional or just starting in the field, here are some indispensable medical coding resources to have in your personal toolbox for referencing and coding more efficiently and correctly.

Current Procedural Terminology (CPT) Codebook

The CPT codebook, published annually by the American Medical Association (AMA), is a foundational resource for outpatient procedure coding. It contains a comprehensive listing of medical procedures and services, along with corresponding codes and guidelines. Investing in the latest edition ensures access to the most up-to-date codes and descriptions.

International Classification of Diseases (ICD) Codebooks

ICD codebooks, specifically ICD-10-CM for diagnosis coding and ICD-10-PCS for inpatient procedure coding, provide a standardized system for classifying diseases, injuries, and procedures. These codebooks are essential for accurate diagnosis code selection and adherence to coding guidelines.

HCPCS

HCPCS stands for Healthcare Common Procedure Coding System and is a collection of standardized codes used in the billing and processing of health insurance claims. HCPCS codes represent medical procedures, supplies, products, and services, and are produced by the Centers for Medicare and Medicaid Services (CMS). HCPCS codes are based on CPT codes, and the first level of HCPCS is identical to CPT.

Official Guidelines for Coding and Reporting

Published by the Centers for Medicare & Medicaid Services (CMS) and the American Hospital Association (AHA), the official coding guidelines provide essential instructions and conventions for correctly assigning ICD and CPT codes. These guidelines address various coding scenarios, such as documentation requirements, code sequencing, and modifier usage.

Encoder Software

Encoder software applications offer valuable assistance in navigating complex code sets and guidelines. These tools allow users to search for codes, access coding guidelines, check code edits, and ensure coding compliance. While there are several commercial encoder software options available, many healthcare organizations provide access to proprietary or licensed encoder systems.

Medical Coding Websites and Online Resources

Numerous websites and online medical coding resources are avaiable, offering a wealth of information, updates, and educational materials. Websites such as the AMA, CMS, AHA, and American Health Information Management Association (AHIMA) provide free access to coding resources, including code lookup tools, educational articles, webinars, and forums for discussing coding-related queries.

Reference Books

Beyond official codebooks, coding manuals and reference books cover specific coding topics in greater detail, offering practical insights and examples. Resources focusing on specialty coding areas, such as anesthesia, radiology, or surgical coding, can be particularly helpful for coders specializing in those areas.

Continuing Education Programs and Workshops

Staying abreast of coding updates and honing coding skills is essential for professional growth. Participating in continuing education programs, workshops, and seminars offered by reputable organizations and coding associations enables coders to expand their knowledge, learn about regulatory changes, and enhance their coding proficiency.

Personalized Code Libraries and Cheat Sheets

Building a personalized code library or creating cheat sheets for commonly used codes, modifiers, and coding tips can streamline the coding process and serve as quick references during busy workdays. These resources can be tailored to individual coding preferences and frequently encountered coding scenarios.

Assembling a comprehensive set of medical coding tools in your personal toolbox is essential for maintaining accuracy, efficiency, and compliance in medical coding practices. By leveraging a combination of codebooks, guidelines, software, online resources, and ongoing education, medical coders can navigate the complexities of coding with confidence and precision.

Top Medical Coding Tools for Your Professional Toolbox

NCCI

CMS publishes the NCCI coding policies, which are updated annually. NCCI is based on AMA’s coding conventions, national and local policies and edits, coding guidelines developed by national societies, analysis of standard medical and surgical practices, and a review of current coding practices. The NCCI promotes national correct coding methodologies and is used to control improper coding.
The Policy Manual for Medicare Services is a general reference tool that explains the rationale for NCCI edits. If you do not read the NCCI guidelines in its entirety, at least read both the Introduction and Chapter 1, General Correct Coding Policies.
NCCI includes three types of edits:
(1) NCCI PTP Coding Edits;
(2) Medically Unlikely Edits (MUE); and
(3) Add-on Code Edits.
Tip: The NCCI policies may differ from the CPT® code book. When coding a Medicaid or Medicare patient’s case, coding should follow NCCI guidelines.
The General Correct Coding Policies for NCCI Policy Manual states:

The American Medical Association publishes CPT Assistant which contains coding guidelines. CMS does not review nor approve the information in this publication. In the development of NCCI PTP edits, CMS occasionally disagrees with the information in this publication. If a physician utilizes information from CPT Assistant to report services rendered to Medicare patients, it is possible that Medicare Carriers (A/B MACs processing practitioner service claims) and Fiscal Intermediaries may utilize different criteria to process claims.

PTP Coding Edits

The PTP edits are CPT® code pairs that should not be coded together. NCCI PTP edits prevent improper payment when incorrect code combinations are reported. Reasons for why specific code pairs should not be coded together are explained in the Policy Manual for Medicare Services.
NCCI PTP edits are used by Medicare claims processing contractors to adjudicate provider claims for physician services, outpatient hospital services, and outpatient therapy services. They are not applied to facility claims for inpatient services.

MUEs

The NCCI MUE program prevents payment for an inappropriate quantity of the same service on a single day. An MUE is the maximum number of units of service under most circumstances reportable by the same provider for the same patient on the same date of service. An Excel spreadsheet of most procedure code MUEs is located at the CMS website. Not all procedure codes are included.
Add-on code edits consist of a listing of HCPCS Level II and CPT® add-on codes with their respective primary codes. An add-on code is eligible for payment only if one of its primary codes is also eligible for payment.

MLN®

Medicare Learning Network®: Global Surgery Booklet provides education on the global surgery package. Uniform payment policies and claims processing requirements have been established for surgical issues. The Global Surgery MLP provides guidance on:

  • Evaluation and management (E/M) services (same day decision for surgery, significant, separately identifiable E/M services by the same physician on the same day of the procedure)
  • Global surgery coding and billing guidelines
  • Pre-operative period billing
  • Day of procedure billing
    • Claims for multiple surgeries
    • Claims for co-surgery
    • Claims for assistant at surgery services
  • Post-operative period billing
    • Return to the operating room (OR) for a related procedure during post-operative period
    • Staged or related procedure or service by the same physician during the post-operative period
    • Critical care
  • Billing for bilateral procedures
  • Global surgery indicators: 000, 010, 090, XXX, YYY, ZZZ

For more information, refer to the Medicare Claims Processing Manual, Chapter 12, Sections 40 and 40.1.

MPFS

The MPFS is a list of CPT®/HCPCS Level II services and procedures. The MPFS provides information on each procedure code, such as the global surgery indicator, multiple surgery indicator, co-surgery/assistant surgery indicator, bilateral procedures, relative value units (RVUs), etc.

OIG- Office of Inspector General

Annual Work Plan
Exclusions Lookup
Compliance Guidance
Corporate Integrity Agreements
RAT_STATS

Specialty Societies

Do not rule out seeking guidance offered by specialties on their websites. For example, American Academy of Otolaryngology — Head and Neck Surgery provides guidelines directed to residents on their website. The information may help you better understand procedures and specific disease processes. For example:

American Association of Ophthalmology

https://www.aao.org/young-ophthalmologists/learn-to-code

American Academy of Otolaryngology

https://www.entnet.org/business-of-medicine/coding-corner/ 

American College of Cardiology

https://www.acc.org/tools-and-practice-support/practice-solutions/coding-and-reimbursement 

American College of Surgeons

https://www.facs.org/advocacy/practmanagement/cpt 

American Association for Respiratory Care:

https://www.aarc.org/advocacy/rt-federal-resources/respiratory-coding-and-billing-instructions/ 

American Thoracic Society

https://www.thoracic.org/about/newsroom/newsletters/coding-and-billing/ 

American Gastroenterological Association: https://gastro.org/practice-guidance/reimbursement/coding/ 

American College of Gastroenterology:

https://gi.org/practice-management/coding-reimbursement/ 

  

American Society for Gastrointestinal Endoscopy

https://www.asge.org/home/practice-support/coding-reimbursement 

ASRM

https://www.asrm.org/resources/coding/ 

ASHA American Speech-Language-Hearing Association

Coding for Evaluation of Auditory Rehabilitation Status

https://www.asha.org/practice/reimbursement/coding/coding-for-evaluation-of-auditory-rehabilitation-status/ 

American College of Radiology:

https://www.acr.org/Advocacy-and-Economics/Coding-Source 

Radiology Assistant:

https://radiologyassistant.nl/ 

American Academy of Orthopedic Surgeons:

https://www.aaos.org/quality/coding-and-reimbursement/ 

American Academy of Neurology:

https://www.aan.com/tools-and-resources/practicing-neurologists-administrators/billing-and-coding/cpt-em/

American Urological Association:

https://www.auanet.org/practice-resources/coding-and-reimbursement/coding-resources-and-information 

American Academy of Dermatology Association: 

https://www.aad.org/member/practice/coding 

American Academy of Dermatology Association:

https://www.aad.org/member/practice/coding 

 

ACOG American College of Obstetrics & Gynecologists:

https://www.aad.org/member/practice/coding 

College of American Pathologists:

https://www.cap.org/member-resources/practice-management/coding-and-payment 

 

Medical Dictionary

Medical dictionaries provide terms and descriptions for procedures, diseases, human anatomy, medical instruments, etc. If you encounter an unfamiliar term, best practice is to look it up.

Novitas Solutions

The Novitas Solutions website is an administrative services processing company for Medicare providers and healthcare industry professionals to use. Novitas administers the Medicare Administrative Contractor (MAC) Jurisdiction L (JL), and Jurisdiction H (JH) for Part A, hospitals and other facilities, and Part B, physicians and other healthcare professionals.
Some resources the Novitas Solutions website offers are:

  • An E/M interactive score sheet. The system helps with coding E/M cases.
  • A list of modifiers, including HCPCS Level II, the Advance Beneficiary Notice, end-stage renal disease, anesthesia, anatomical, etc.

Check your MAC’s website for similar offerings relative to your jurisdiction.

CMS (Claims Processing Manual)

Medicare offers an online Claims Processing Manual, which provides day-to-day operating instructions, policies, and procedures based on statutes and regulations, guidelines, and directives. 

What’s Inside the Manual?

In total, the manual is broken up into 39 chapters, each one covering a specific topic about Medicare claims. In addition to a few overviews, the chapters are broken up by the type of facility or service to be billed


The CMS website is filled with educational information such as the guidelines for teaching hospitals, definitions (co-surgeon, assistant surgeon, etc.), internet-only manuals (IOMs), future updates to the IOM, paper-based manuals, transmittals, and quarterly provider updates.
Of the 38 chapters that comprise the IOM, chapters that provide general coding guidelines to the medical coder and to other healthcare providers are listed here:

https://www.cms.gov/regulations-and-guidance/guidance/manuals/internet-only-manuals-ioms-items/cms018912 

AAPC– https://www.aapc.com/ 

Free tools https://www.aapc.com/resources/free-tools/ 

AHIMA –https://www.ahima.org/

If you have questions about the difference between AAPC and AHIMA certifications you can refer to our recent blog.

CPT®

 

ICD-10-CM

 

HCPCS Level II codes

 

EMR Resources 

Health IT

 

CCHIT-certified 2011 EMR Products

 

Ambulatory EHR

 

Emergency Dept EHR

 

Inpatient EHR

 

ePrescribing

 

ARRA Articles

 

Government 

Health Plans 

Other Organizations 

Practice Management 

OSHA Regulations

 

Human resources

 

Drug Enforcement Administration

 

Free software

 

HIPAA

 

Publications 

Risk Adjustment 

Risk Adjustment Search

 

PQRS 

PQRS Measure Search

 

Specialty Societies 

Anesthesia

 

Cardiology and Cardiovascular surgery

 

Dermatology

 

Emergency

 

Family Practice/Internal Medicine

 

Gastroenterology

 

General surgery

 

Neurology/Neurosurgery

 

Obstetrics/gynecology

 

Oncology

 

Ophthalmology

 

Orthopaedics

 

Osteopathy

 

Otolaryngology

 

Pediatrics

 

Plastic and Reconstructive Surgery

 

Radiology

 

Urology

 

Conclusion: Equip Your Toolbox with the Best Medical Coding Tools

Having the right tools in your medical coding toolbox is essential for maintaining accuracy, efficiency and staying updated with the latest coding standards. Whether you are just starting in the field or looking to enhance your existing skills, these essential tools will support your journey as a medical coding expert.

Ready to Take Your Medical Coding Skills to the Next Level?

For those who are new to medical coding or looking to expand their expertise, consider exploring these additional resources:

  • Medical Coding Training: Our comprehensive course designed to provide you with in-depth knowledge and practical skills in medical coding.
  • What is Medical Coding?: A detailed overview from AHIMA about what medical coding entails, the role of a medical coder, and the impact of accurate coding on healthcare.

Investing time in learning and utilizing the best tools will not only improve your proficiency but also open up new career opportunities in the ever-evolving field of medical coding.

Stay ahead of the curve, and make sure your toolbox is equipped with the most effective and up-to-date tools for medical coding available.

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