Medicaid Alert - Attention: All Providers - Implementation of Additional Correct Coding Edits: Age/Gender and Add-on Codes

dditional correct coding edits for Age/Gender and Add-on codes will be implemented on June 1, 2011 for dates of service on or after June 1, 2011. Age/Gender edits will ensure that the appropriate CPT and HCPCS codes are utilized based on the age and gender of the patient. Add-on codes are designated in the CPT Manual with a “+” symbol and frequently contain descriptions such as “each additional” or “list separately in addition to primary procedure.” DMA will not allow an Add-On code in the absence of a primary procedure code. The Add-On edits will ensure that if a procedure code is submitted that requires a primary procedure code, DMA will verify that the primary procedure code has also been submitted for processing. If the primary procedure code is not identified within the claim processing system, then the claim line will deny.
As previously announced in the May bulletin, DMA will begin implementing additional correct coding guidelines. These new correct coding guidelines and edits will be nationally sourced by organizations such as the Centers for Medicare and Medicaid Services (CMS) and The American Medical Association (AMA). These edits will identify any inconsistencies with CPT, HCPCS, AMA, CMS and/or DMA policies and will deny the claim line.
Providers are encouraged to frequently visit DMA’s NCCI web page (http://www.ncdhhs.gov/dma/provider/ncci.htm) and to review published bulletin articles for information on the project status. Providers may contact the HP Provider Services Call Center at             1-800-688-6696      , menu option 3.

Dallas L Alford IV, CPA is a licensed Certified Public Accountant in the state of North Carolina and owner of Atlantic Financial Consulting, a consulting firm that provides comprehensive medical billing services, practice management consulting, coding audits, Medicare compliance, Medicare RAC support and other general medical practice consulting services.
To learn more about Atlantic Financial Consulting you may visit their website at http://atlanticfinancial.us or contact Dallas L Alford IV, CPA directly at             1 888-428-2555      , Ext. 200.