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Coding and Billing

For better or worse, codes determine your reimbursement. Correct coding also keeps the auditors away.

The WSMA provides guidance on CPT, ICD-9 and HCPCS coding and billing below. For additional, personalized assistance from WSMA's certified coders, contact our Physician Practice Helpline. Having trouble resolving a claim with an insurer? Check out WSMA insurance claim assistance  (for WSMA members only).

Administrative simplification

OneHealthPort: Administrative simplification guidelines

Billing: Electronic funds transfer (EFT) 

Virtual Credit Cards

Care management service

Medicare CMS MLN guidance: Transitional care management

Medicare CMS MLN guidance: Chronic care management

WSMA coding guidance: Summary of care management services

WSMA coding guidance: CCCC and TCM codes for 2013

AAFP tools for transitional care management

CMS Medicare annual wellness visit

CMS Med Learn Matters on annual wellness visits (AWV)

CMS quick reference: ABCs of providing the annual wellness visit

CMS quick reference guide on preventive services

AAFP question & answers on the annual wellness visits

Computer-assisted coding

"Computer-assisted coding: Boon for physicians’ practices?"  – WSMA Reports article, May/June 2012

ICD-10

AMA resources

CMS ICD-10 Resources

Health data consulting – Dr. Joe Nichols

Insurance claims assistance

WSMA insurance claim assistance (for WSMA members only)

Medicare Advantage Risk Adjustment Program

WSMA white paper: Medicare Advantage Risk Adjustment Program

Medical record documentation

CMS MLN: "Preparing/Maintaining Legible Medical Records"

CMS fact sheet: "Medicare Claim Submission Guidelines"

Modifier 25 – when to use

Preventive vs. Sick Visit: How and When to Use Modifier 25!

Telemedicine

WSMA resource (revised Oct. 2017) – Telemedicine: Coding and Billing Guidance

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