Coding Checklist
Pre-submission checklists for Medicare and private payer claims
Medicare Coding Checklist
Before submitting a Medicare claim, confirm the following:
Private Payer Coding Checklist
When billing commercial or private insurance carriers, ensure the following:
Additional Reference Information
Source
Medicare Carrier Manual (IOM) Publication 100-04
Medicare Claims Processing Manual
Revision 912 (04-21-06)
Revision 999 (07-14-06)
Chapter 12: Physician/Nonphysician Practitioners
Section 40.3 — Claims Review for Global Services
A. Relationship to the Correct Coding Initiative (CCI)
Medicare's Correct Coding Initiative (CCI) policies and automated edits help carriers identify situations where providers bill separately for intra-operative or same-day services that are considered integral components of a surgical procedure.
These services are generally included in the global surgical payment and are not separately reimbursable.
When both correct coding edits and global surgery edits apply to the same claim, Medicare carriers:
- Apply correct coding (CCI) edits first
- Then apply global surgery edits to the appropriately coded services
Section 40.1 — Definition of a Global Surgical Package
Medicare assigns a postoperative global period to each surgical procedure. These global periods are designated as:
Major Procedures (90-Day Global)
Procedures with a 90-day global period include:
- The day before surgery
- The day of surgery
- 90 days following the procedure
All related postoperative care during this period is considered part of the global package.
Minor Procedures (0- or 10-Day Global)
- A 10-day global includes the procedure date plus 10 days of postoperative care
- A 0-day global includes only services provided on the same day as the procedure
Carrier-Priced Codes (YYY Indicator)
Codes assigned YYY are priced by the Medicare carrier, which determines whether the global period is:
- 0 days
- 10 days
- 90 days
Not all carrier-priced codes display the YYY indicator, as some may have a specified global period.
Add-On Codes (ZZZ Indicator)
Codes assigned ZZZ are add-on procedures that must be billed with a primary service.
- These codes do not include postoperative work in the fee schedule
- Payment is made for both the primary and add-on services
- The global period of the primary procedure applies