Pro Part B

CodeCheck Pro Part B is the place for you to enter full CMS1500 claims to perform a single check for CCI and Medical Necessity issues.

Pro Part B checks many of the relationships on CMS1500 forms, including code validity for up to 10 line items (CPT and Modifiers), and up to 10 Diagnoses, plus Local and National Coverage Determinations. The online form mimics the print form for your convenience. The results are returned by procedure RVU.

Perform a Pro Part B CodeCheck

Use this procedure to check the relationships on CMS1500 forms, including code validity, diagnoses, plus Local and National Coverage Determinations. Hover over any field to see its definition in a tooltip.

Procedure

Select CodeCheck > Pro Part B. The CodeCheck Pro Part Input page opens.
Select a Date of Service. The date of service that you select will automatically populate in the Date-of-Service column of the Procedure Information section.
Select a Date of Birth. This step is optional, but recommended, as it allows Knowledge Source to flag age-related issues on your claim.
Select a Gender. This is optional, but recommended, as it allows Knowledge Source to flag gender-related issues on your claim.
Choose a Default State . The Default Payer populates based on the selected default state.
Enter up to 12 Diagnosis codes. When you enter a code, a short description appears to the right of the field. This helps you know that the code is valid. Hover over the description to see its entirety in a tooltip.
In the Procedure Information section, up to 30 rows are supported. if you complete the rows displayed, a new blank row appears. To manually add a row, click Add Row.
- Select a Place of Service.
- Enter at leaset one CPT/HCPCS code. When you enter a code, a short description appears to the right of the field. This helps you know that the code is valid. Hover over the description to see its entirety in a tooltip.
- Enter a Days/Units number.
- Enter a Modifier. You can enter up to three, but remember that print claims only allow two. When you enter a modifier, an information icon appears to the right of the field. This helps you know that the modifier is correct. Click the icon to be navigated to the Modifier Detail page in KnowledgeSource.
- Enter Diagnosis Pointers.
  Note: The data in the Place of Service, Days/Units,and Diagnosis Pointers fields is NOT used while calculating the output at this time and will be available in a future release. The Diagnosis Pointers will default to all procedure codes as it does in Production today.

Click Validate CodeCheck.

Note: Clicking Reset clears the form.

View Pro Part B CodeCheck Results

After you enter your Part B CodeCheck values and click submit, the page refreshes with your CodeCheck CMS 1500 results. Included at the top of the page are the Default State, Default Payer, Patient DOB and Patient Gender that you specified on the Input page.

Note: You may see a warning message to make you aware that the diagnosis code you entered on the Input page requires one or more additional characters and was not checked for medical necessity. To find a complete code, you can click the hyperlinked diagnosis code in the ICD-9/ICD-10 column to be navigated to a page of all related ICD-9 or ICD-10 codes.

Refer to the field description table for descriptions of each icon and what information they describe.

Note: To return to the Input page to re-input your CodeCheck Pro Part B data into the form, click the button at the bottom of the page.

Field Descriptions

The following table describes the fields in your search results for CodeCheck Pro 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. Displays when a HCPCS code is invalid.
RVU (Non-Fac)	Shows RVU when it is > 0.
Modifiers	A check indicates a valid CPT/Modifier pairing. An exclamation point indicates an invalid pairing.
HCPCS Description	A description of the CPT/HCPCS code.
Diagnosis 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.
HCPCS Notes	When a red check mark appears in the icon , there are HCPCS notes available. Click the icon to open the notes associated with this CPT/HCPCS.
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.
CCI Edits
	Indicates a CCI exception.
LCD and NCD Edits
LCD and NCD Edits	Shows Local Coverage Determination Policy matches, if any, for your CPT/HCPCS/ICD-9/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 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.