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Practice Management Coding Questions

What is CPT - ICD9 code linking and pointing?
By Marty Kotlar, DC, CHCC, CBCS

Q:I am not sure what CPT - ICD9 code linking and pointing is. Can you explain?

A:In order for your services to be considered reimbursable, many insurance companies want your CPT codes to be compatible or "link" to your ICD9 codes. Many carriers also want to see your CPT codes "point" to the most appropriate ICD9 codes on the CMS-1500 claim form.

To understand how to become an expert at linking and pointing, you'll need to become more familiar with the "anatomy" of the CMS-1500 claim form, especially boxes 24D, 24E, and 21.

Box 24D of the CMS-1500 claim form is for CPT (and HCPCS) codes.

Box 24E is for the diagnosis reference number(s) 1, 2, 3, or 4 as they relate to the four diagnosis code positions in Box 21.

Box 24E is labeled "diagnosis pointer." This is one of the revisions that took place with the creation of the new CMS-1500 Claim Form (08/05).

Do not enter ICD9 codes in Box 24E. They should be entered in Box 21. A written description of your diagnosis codes in Box 21 is not necessary. You should try and fill all four positions in Box 21 (but only if clinically indicated). Figure 1 gives an example.

In figure 2, Box 24D indicates that a patient received a chiropractic manipulative treatment (98940), mechanical traction (97012), and manual therapy techniques (97140-59).

Box 24E indicates that CPT codes 98940 and 97012 are linked to diagnosis codes 723.1 (cervical pain) and 739.1 (cervical segmental dysfunction/subluxation), and these CPT codes are pointing to these two ICD9 codes by using diagnosis reference numbers 1 and 2.

Box 24E also indicates that CPT code 97140-59 are linked to diagnosis codes 724.2 (lumbar pain) and 847.2 (lumbar sprain/strain) and are pointing by using diagnosis reference numbers 3 and 4.

Hundreds of CPT - ICD9 code pointing and linking combinations exist. Do your best to learn about this very important aspect of billing and coding.

Figure 1
BOX 21. DIAGNOSIS OR NATURE OF ILLNESS OR INJURY
(Relate items 1, 2, 3, or 4 to Item 24E by Line)
1. 723.1 3. 724.2
2. 739.1 4. 847.2

 

Figure 2
BOX 24D. CPT/HCPCS BOX 24E.
DIAGNOSIS POINTER
1. 98940 1, 2
2. 97012 1, 2
3. 97140-59 3, 4

Editor's note: CMS announced a delay in using its new CMS-1500 form. See page 5 for more information.

An important note
The National Correct Coding Initiative or CCI edits (created by CMS) requires manual therapy techniques (97140) to be performed in a separate anatomic region than the chiropractic adjustment. Therefore, in the example, 97140 needed the 59 modifier to indicate that it is a distinct procedure and is being performed at a different anatomic site.

Image Headshot Marty KotlarMarty Kotlar, DC, CHCC, CBCS, is president of Target Coding. Target Coding, in conjunction with Foot Levelers, offers continuing-education seminars on CPT coding and compliant documentation. He can be reached at 800-270-7044, through his Web site at www.TargetCoding.com, or by e-mail at drkotlar@targetcoding.com.

   
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