PAGE: 1 of 4 / REPLACES POLICY DATED:10/11/99, 9/1/02(HIM.PHY.004), 3/1/06(GOS.OSG.004), 3/6/06
EFFECTIVE DATE: July 1, 2009 / REFERENCE NUMBER: REGS.OSG.004
APPROVED BY: Ethics and Compliance Policy Committee
SCOPE: All personnel responsible for performing, supervising or monitoring coding/claims processing for Outpatient Services Group entities:
Administration
Ambulatory Surgery Division (ASD)
Ethics and Compliance Officer
HCA Physician Services (HCAPS)
Imaging Services Division (ISD)
Oncology Services Division (OSD)
OSG Practice Management, operations, and coding/billing consultants
Owned Freestanding Outpatient Centers (i.e., ASC, IDTF, physician directed clinics, clinical
offices, radiation oncology, catheterization lab)
Employed Physicians, non-physician practitioners and physicians at teaching hospitals
Shared Services Centers (SSC)
PURPOSE: The Coding and Billing Helplinesare available to provide quality advice for complete, accurate and consistent coding and billing related to ICD-9-CM, CPT and HCPCS Level II code assignments for federally funded programs.
POLICY: The Coding and Billing Helplines should be utilized to provide consistent answers and/or advice regarding coding and billing questions.
The 3M Nosology Coding Help Line, operated by 3M Nosology staff, is available to all
OSG entities that purchase a yearly subscription.
PROCEDURE:
- Questions requiring assistance related to ICD-9-CM diagnosis or procedure codes, CPT/HCPCS Level II procedure codes or sequencing/linking,will be referred as follows:
b)OSG entities without a 3M Nosology yearly subscription should email the Regs Helpline via Outlook at .
c)Questions requiring assistance related to topics other than coding should be directed to the .
- Questions or issues related to Regulatory Compliance Support policies and procedures should be directed to the .
- The following information should be provided when submitting a question to the Regs Helpline: the name of the requestor, the entity name, COID#, city, state, and telephone number including area code.
- 3M Nosology Coding Helpline – Contact information is located on the main page of the 3M Coding and Reimbursement System under “Contact Us.” The following telephone numbers may be used to contact the specific support area:
Coding Support (800) 537-1666
a)For coding support the caller must select from one of the following menu options when contacting the 3M Nosology Coding Help Line:
Option 1: Technical support (e.g., software issues or options)
Option 2: Sales (Direct any purchase questions to Corporate IT&S.)
Option 3: Coding Support (i.e., CPT, ICD-9-CM, HCPCS Level II)
b)The call will then be directed to a member of the 3M Nosology staff.
c)The caller should be prepared to provide their name, the entity name, customer number, facility COID Number, city, state, and telephone number including area code.
d)The caller should then discuss the coding question.
e)If a nosologist is not available, the call will be placed in queue by one of the following methods:
i)The call may be answered by a 3M Nosology support staff member who will provide the caller with an incident number. Record thisincident numberfor future reference. A Nosology staff member will return the call as quickly as possible or by the next business day if the call was placed during non-business hours. Business hours for the Coding Help Line are from Monday - Friday, 8:00a.m. - 5:00 p.m. MST, OR
ii)The caller will be connected to a voice-mail box and asked to leave a detailed message with contact information. A Nosology staff member will return the call as quickly as possible or by the next business day if the call was placed during non-business hours. Business hours for the Coding Help Line are from Monday - Friday, 8:00 a.m. - 5:00 p.m. MST.
f)The nosologist and the caller will discuss the coding question. This may include, but is not limited to, reading documentation from the medical record or faxing (patient name, account number and medical record number must be removed from document) documentation to the nosologist. The nosologist will provide coding advice in response to the question. This coding advice should contain any reference to the AHA Coding Clinic, CPT Assistant or other references used by the nosologist to respond to the question.
g)Questions may be submitted via the online 3M Customer Care Website. Registration is required to use this feature.A link to this website is located on the main page of the 3M Coding and Reimbursement System under “Contact Us.”
- Generally, within 24 hours or the following business day, the respective helpline will acknowledge receipt of the question.
i)Remove all patient identifying information from any document(s) supplied and send all corresponding information to the number given to the representative’s attention.
ii)The Helpline representative will provide coding/billing advice in response to the question. This coding/billing advice should contain any reference to AHA Coding Clinic, CPT Assistant, Medicare Manuals, CMS Transmittals, or other references used by the representative to respond to the question.
b)A written or verbal response will be provided as appropriate. In most cases a response may be expected within 3 business days.
i)If the caller does not agree with the advice received from a 3M Nosology representative, articulate the reason for disagreement with the recommended response and ask that the representative obtain another opinion on the subject.
ii)Conclude the call and maintain the incident number; conduct additional research; return a call to the representative citing the incident number and discuss further. If the caller still disagrees with the representative’s advice, ask to speak with a supervisor.
iii)If there is still disagreement with the advice being proposed by the representative, contact .
iv)The entity has the responsibility for final decision. Any related physician query form should be generated, completed and maintained. Documentation of the final decision should be maintained and accessible.
- For CPT coding questions that 3M Nosology is unable to answer, contact Regs Helpline for assistance.Discuss the question and explain that the 3M Nosology representative was unable to provide an answer. Regulatory Compliance Support will either provide an answer or submit the question to the American Medical Association or other appropriate source for clarification.
9.Any coding advice from 3M Nosology requiring further clarification will be discussed with the 3M Nosology staff. If the Regs and 3M Nosology agree that inappropriate advice was provided to a caller/requester, 3M Nosology will contact the caller/requester to clarify the issue. This clarification will be recorded by the Regs for future reference. Recurrent coding questions will be addressed byRegs for continuous coding education to support complete, accurate, and consistent coding.
5/2009