Medicare Correct Coding Guide Contents Introduction ...................................................................................................................................................................................................................................................Introduction–1 Resource Based Relative Value System (RBRVS) Payment Computation ........................................................................................................................Introduction–1 Relative Value Units ...................................................................................................................................................................................................Introduction–1 PE-RVU Transition .......................................................................................................................................................................................................Introduction–1 Conversion Factor .......................................................................................................................................................................................................Introduction–1 Geographical Practice Cost Indices ............................................................................................................................................................................Introduction–1 General Formula for Calculating Payment ................................................................................................................................................................Introduction–2 Modifiers ...............................................................................................................................................................................................................................Introduction–2 Surgical Modifiers .......................................................................................................................................................................................................Introduction–2 Modifiers Affecting Correct Coding Edits ..................................................................................................................................................................Introduction–2 Other Payment Indicators ....................................................................................................................................................................................................Introduction–3 Status Indicator ...........................................................................................................................................................................................................Introduction–3 Global Period ..............................................................................................................................................................................................................Introduction–3 Physician Supervision Level ......................................................................................................................................................................................Introduction–3 Definitions ....................................................................................................................................................................................................................Introduction–3 Levels of Physician Supervision Diagnostic Tests.....................................................................................................................................................Introduction–3 Correct Coding Initiative (CCI) ..............................................................................................................................................................................................Introduction–4 The Commercial "Black Box" Edits......................................................................................................................................................................................Introduction–4 Manual Organization ...........................................................................................................................................................................................................Introduction–5 How to Use ...........................................................................................................................................................................................................................Introduction–5 Step by Step Instructions ............................................................................................................................................................................................Introduction–5 Code Pair Additions ................................................................................................................................................................................................................. Summary of Changes–1 Code Pair Deletions ...............................................................................................................................................................................................................Summary of Changes–13 Modifier Revisions ................................................................................................................................................................................................................Summary of Changes–15 General Correct Coding Policies .....................................................................................................................................................................................................................General–1 A. Introduction ............................................................................................................................................................................................................................General–1 B. Coding Based on Standards of Medical/Surgical Practice ..................................................................................................................................................General–1 C. Medical/Surgical Package .....................................................................................................................................................................................................General–2 D. Evaluation and Management Services .................................................................................................................................................................................General–3 E. Standard Preparation/Monitoring Service ............................................................................................................................................................................General–3 F. Anesthesia Service Included in the Surgical Procedure .......................................................................................................................................................General–4 G. Coding Services Supplemental to a Principal Procedure (Add-on Codes) .........................................................................................................................General–4 H. Modifiers ................................................................................................................................................................................................................................General–4 I. HCPCS/CPT Procedure Code Definition .................................................................................................................................................................................General–5 J. HCPCS/CPT Coding Manual Instruction/Guideline ...............................................................................................................................................................General–5 K. Separate Procedures ..............................................................................................................................................................................................................General–6 L. Family of Codes ......................................................................................................................................................................................................................General–6 M. Most Extensive Procedures ..................................................................................................................................................................................................General–6 N. Sequential Procedures ..........................................................................................................................................................................................................General–6 O. Laboratory Panels ..................................................................................................................................................................................................................General–6 P. Misuse of Column 2 Code with Column 1 Code .................................................................................................................................................................General–6 Q. Mutually Exclusive Procedures..............................................................................................................................................................................................General–7