Fac Part B

CodeCheck Fac Part B is the place for you to enter full UB04 claims to perform a single check for CCI Edits, Modifier and Revenue Code applicability, and Medical Necessity issues.

Fac Part B checks the relationships on UB04 forms, including code validity, for up to 20 line items (CPT, Modifiers, and Revenue Codes), up to 19 diagnoses, plus Local and National Coverage Determinations. The online form mimics the print form for your convenience. The results are returned in order of procedure relative weight.

Perform a Fac Part B CodeCheck

Use this procedure to check many of the relationships on UB04 forms, including code validity, diagnoses, plus Local and National Coverage Determinations.

Procedure

Select CodeCheck > Fac Part B. The UB04 Input page opens.
Select a Date of Service.

Note: The date of service that you select will automatically populate in the first line item Date of Service field.

Select a Diagnosis of ICD-9 or ICD-10.

Note: When you select a date of service that is before the ICD-10 cutover date of October 1, 2015, the ICD radio button automatically defaults to ICD-9. Otherwise, the default is ICD-10.

Verify the Default State is entered correctly.
Verify or select a Default Payer. Default Payer options are based on the State and Date of Service.

Note: Payer defaults to the assigned Payer for the State selected. The exception to this is WPS- J5 National, which is shown as a Part A payer option for all states. To see policy results including WPS- J5 National, you must select it specifically from the payer list.

Enter the Date of Birth. (This step is optional, but recommended).

Note: Providing a date of birth allows KnowledgeSource to flag age-related issues on your claim. If you type the date into the field, please use the date format YYYY-MM-DD.

Example: 1962-11-14

Select the patient’s Gender. (This step is optional, but recommended).

Note: Providing the gender allows KnowledgeSource to flag gender-related issues on your claim.

Enter the row information for CPT/HCPCS (up to 20 rows supported), Modifiers (up to 3 per row), Rev Code (required), and Date of Service (required).

When you complete a row (CPT/HCPCS/Revenue Code) a new blank row appears.
You can manually add a row by clicking the Add Row button at the bottom of the page.
The date of service defaults to the date as indicated in the Date of Service field on the toolbar. If you manually change the date in the form, please use the date format YYYY-MM-DD.
- You may see a warning message if your manual change to the Date of Service produces a different payer than the Default Payer, to make you aware of the impact of the change.

Enter a relevant ICD-9DX Code.
Enter any Secondary ICD-9DX Codes.
Click Submit.

Note: Clicking Reset clears the form. A warning message helps prevent you from unintentionally clearing your form.

View Fac Part B CodeCheck Results

After you enter your Fac Part B CodeCheck values and clicked submit, the page refreshes with your results.

Any applicable CCI issues are shown in a table at the bottom of the page. When shown, the table displays the codes involved in the edit, the edit type, and applicability of a modifier in resolving the issue.
Effective 1/1/09, the Facility version of the NCCI Edits include edits for the following categories of service: Anesthesia (00100-01999), E&M (92002-92014, 99201-99499), and MH (90804-90911). Prior to 2009, these code pairs were excluded from the Facility edits.

Note: To return to the "input" page to re-input your CodeCheck data into the form, click the button on the bottom of the page.

Field Descriptions

The following table describes the fields in your search results for CodeCheck Fac Part B. Not all fields may be relevant to your particular search.

Field	Description
HCPCS Code	Indicates the code is valid. Indicates the code is valid but expired. Indicates there is an add-on code; these codes cannot be billed on a claim without a second specific code. Displays when there are "see also" codes linked to this code.
Weight	Shows payment weight when it is > O.
Modifiers	A check indicates a valid CPT/Modifier pairing. An exclamation point indicates an invalid pairing.
Revenue Code	Displays as valid or invalid. When the Revenue Code is valid, a hyperlink takes you to the code details page.
HCPCS Description	A description of the CPT/HCPCS code.
ICD-9 & ICD-10 Column Indicators
	Indicates a valid code.
	Indicates an additional digit required.
	Indicates a Manifestation Code.
	Other Specified Code
	Unspecified Code
Field	Description
ABN (Advanced Beneficiary Notification)	Indicates the need for an ABN based on the CPT/HCPCS - ICD-9/ICD-10 pairing: Yes - ABN is required. No - ABN is not required ? - You have entered codes that may require an ABN, but will depend on additional policy validations. Click the policy link or policy advice icon for more details.
APC	If the CPT/HCPCS is payable by APC, the APC code is shown, and is a link to code details.
RPT/Reim	Shows devices linked to the selected CPT/HCPCS: Indicates a possible reportable device Indicates at least one device is required
HCPCS Notes	When a red check mark is present in the icon, there are HCPCS notes available. Click the icon to view the notes.
User Defined Edits	Appears if your clinic has any user-defined edits for the code combination. Those are shown as either a red square or green circle.
LCD and NCD Edits
LCD and NCD Edits	Shows Local Coverage Determination Policy matches, if any, for your CPT/HCPCS/ICD-9/ICD-10/Carrier/FI combination. Click "L" or "N" to open a new tab that contains policy details.
	No LCD/NCD Policy found.
	CPT/HCPCS was found in an LCD, but may not directly relate to coverage.
	ICD-9/CPT match found in LCD database; also shows with valid E&M codes
	ICD-9/CPT match found in LCD database; also shows with valid E&M codes, and includes FinThrive advice.
	Possible Medical Necessity issue. Click on the yellow dot for details.
	Possible Medical Necessity issue. Click on the yellow dot for details, and includes FinThrive advice.
	ICD-9/CPT linkage contradicts a policy in the LCD/NCD database, or the combination is excluded or not covered.
	CD-9/CPT linkage contradicts a policy in the LCD/NCD database, or the combination is excluded or not covered, and includes FinThrive advice.
	Codes Medicare will never cover.
	Codes Medicare will never cover, and includes FinThrive advice.
Age/Gender	Any age or gender issues applicable to the CPT/HCPCS code or any ICD-9/ICD-10 on the claim is indicated at the bottom of the CodeCheck results Shows for any codes with gender or age edits if there is no age or gender specified on the claim. Shows for any codes that conflict with a specified age or gender.