Reimbursement FAQ

NAVIGATION

Summary

Notice and Disclaimer

Glossary

Asthma Diagnosis Codes

Medications

Medicare Guidelines

The reimbursement section of the NAECB website was developed to assist with coding, billing, and reimbursement for patients with asthma. We are gathering information that is state-specific for Medicare and Medicaid reimbursement guidelines and will add specific, local Managed Care Organizations in the future.

What is coding and were do these codes come from?

The American Medical Association (AMA) and Centers for Medicare and Medicaid Service (CMS) determine the codes and descriptions of services. The codes are reviewed, revised and published each year and are available through several sources such as medical bookstores, AMA (catalog.ama-assn.org/Catalog/home.jsp) or Ingenix (www.codingbooks.com).

CPT Book – The Current Procedural Terminology (CPT) book is used by physicians, hospitals and outpatient settings to identify services or procedures provided to a patient.

HCPCS Book, I, II & III – The Healthcare Common Procedural Coding System (HCPCS) book is used to identify drugs, equipment and supplies provided to patients in various healthcare settings.

ICD-9-CM – The International Classification of Diseases (ICD) codes, 9th edition and clinical modification (CM), is used by healthcare providers to accurately describe a patient’s diagnosis.

How do I find out if my state database is posted?

The states that have posted databases are highlighted in green on our USA map and can be viewed at www.naecb.org/cbr/state.htm. Simply click on your state to view the relevant coding information. Information of more national usage (e.g., Medicare codes) are found directly off the reimbursement section “home page” (www.naecb.org/cbr).

My state database is not posted … how can I volunteer to help get this done?

You can email Sabra Caldwell (reimbursement specialist) at scaldwell@naecb.org. She has developed a standard template to gather specific coding information to help compile coding data for your state. You do not need to be a coding expert to help with this project. We do encourage people to develop a small committee with both clinical experience (i.e., healthcare professionals) and billing/coding expertise (i.e., administrators) to help identify and interpret local codes and procedures.

How do I get started gathering information for my state?

The first payer we focus on in each state is Medicaid. You can typically retrieve information by searching your state’s Medicaid website. Look for information under the fee schedules and provider manuals section.

I would like to be notified about future posting and information regarding coding and reimbursement. Can you put me on a mailing list?

Yes, our contact database allows us to add your name and email address and send out new information. If you would like to add your name to our database, please email scaldwell@naecb.org and provide your name, degree, mailing address, and preferred email address.

I have reviewed my state’s information and have new information regarding coding coverage for my state. How do I let you know about these changes?

On the coding pages, you will find an edit button next to each procedure code. If you’d like to submit suggestions or new information, you can click on the edit button and send us the information. The email is sent to Sabra Caldwell and she will review and post any new changes.

Thanks in advance for your help! We could not complete this important work without the help of hundreds of volunteers like you. For a list of those who already have worked on this project, please see the acknowledgements section: www.naecb.org/cbr/acknowledge.asp. We hope to hear from you soon!

To return to the reimbursement site, please click here: www.naecb.org/cbr/.