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and CrossCoder.Com™ are trademarks of Yale Wasserman
D.M.D. Medical Publishers and The
National Medicare Advisory Service™
Medical to Diagnosis Code Crosswalks
and HCPCS Level II Codes and find supporting ICD10 Diagnosis Crosswalks
(HCPCS to ICD10) in seconds. Also perform reverse searches (ICD10 to
HCPCS). Over 4,000,000 links including detailed LCD (Local Coverage
Determination) policy details. This product is a must for
validating medical necessity.
DEMO Standard Version
Only $249! Professional
Version (includes exporting privileges) $999
is your low cost Windows
solution for finding "crosswalks" or links between CPT®
/HCPCS procedure and service codes with supporting ICD10 diagnostic
A "crosswalk" or "link" refers to a relationship between
a Medical Procedure (CPT/HCPCS Code) and a Diagnosis (ICD10 Code).
and other payers use crosswalks to validate or substantiate medical necessity
based on Local Coverage Determinations (LCD) and
National Coverage Determinations (NCD). Private payers also establish crosswalk tables
for validating and auditing medical claims. CrossCoder
provides instant access to all active CMS LCD/NCD policies. Procedure
and diagnostic codes are extracted form these polices and combined with our own NMD (National Medicare Database)
crosswalks based on millions of claim data records.
CrossCoder allows lookup for over 12,000 medical
service/procedure codes including CPT, HCPCS Level II, DMEPOS, J Codes,
Anesthesia, Category II and III ( F and T codes) and over 70,000 ICD10 diagnosis codes including
accident and injury codes. Exclusive to CrossCoder is the ability
to perform reverse searches from Diagnosis to Procedure Codes.The
result is over 4,000,000 crosswalks. The Professional Version exports
these crosswalks to Excel or MS Access.
Also included: ICD9 to CD10 GEM (General
Equivalency Mappings) lookup. The purpose of the GEMs is to create a
useful, practical, code to code translation reference dictionary
for both code sets, and to offer acceptable translation alternatives
In brief, physicians are paid by procedure or
service code - not by diagnosis. In order to validate proper coding (e.g. the reason for the
procedure or medical necessity) providers must specify a medically
necessary diagnosis. If the diagnosis does
not support the procedure the claim will be rejected
casing delays and possible audit if a pattern of inappropriate
claim submission persists.
Medicare and many private payers use medical
necessity crosswalks to audit your claims - why not use a tool that may have the same links they
and lower your audit exposure!CrossCoder is being used by providers, administrators, private payers, managed care,
HMO/PPO/TPAs, billing services, researchers and health care consultants.
The CrossCoder has two versions: Standard
($249) and Professional ($999). The CrossCoder Professional
Version provides users with full exporting privileges.
For additional information see the FAQ.
is based on 3 sources:
Coverage Determination (NCD): Medicare
coverage is limited to items and services that are reasonable and
necessary for the diagnosis or treatment of an illness or injury
(and within the scope of a Medicare benefit category). The NCDs are
developed by CMS to describe the circumstances for which Medicare
will cover specific services, procedures, or technologies on a
national basis. Medicare Contractors are required to follow NCDs. If
an NCD does not specifically exclude/limit an indication or
circumstance, or if the item or service is not mentioned at all in
an NCD or in a Medicare manual, it is up to the Medicare contractor
to make the coverage decision.
Coverage Determinations (LCD): In
the absence of a national coverage policy, an item or service may be
covered at the discretion of the Medicare Contractors based on a
local coverage determination (LCD). Local Coverage Determination (LCD) crosswalks are Part B contractor developed coverage policies, pertaining to services or items not addressed in National Coverage Determinations (NCDs) or program manuals. LCDs contain CPT & ICD10 coding, guidelines and related policy information. LCDs are developed to define the appropriate use of new technologies, address services with an abuse history or potential and high volume and high dollar services.
Medicare Database (NMD): Ccrosswalks
based on an independent analysis of CMS' LDS data files containing millions of validated claims.
For Windows PC 7/8/10