CrossCoder | Cross Coding Software for Medical Necessity

A “crosswalk” or “link” refers to a medical necessity relationship between a Medical Procedure (CPT/HCPCS) Code and a Diagnosis (ICD10) Code

Search Both Ways

Lookup CPT or HCPCS Level II Codes and find supporting ICD10 Diagnosis Crosswalks in seconds. Also perform reverse searches from ICD10 to CPT/HCPCS

Both Versions

Standard Version: Access to over 16,000 CPT/HCPCS Codes and 94,000 ICD10 Codes and over 5.2 million crosswalks $249

Professional Version: Same features as Standard but with full export privileges $999

Reports And Documentation

Print LCD (Local Coverage Determination) and LCA (Local Coverage Article) policies with detailed explanations of Medical Necessity with Indications and Limitations of Coverage.

Why CrossCoder?

Medicare and other payers use crosswalks to validate or substantiate medical necessity based on Local Coverage Determinations (LCD) and Articles (LCA). Private payers also establish crosswalk tables for validating and auditing medical claims. CrossCoder provides instant access to all active and retired CMS Policies and Articles. Procedure and diagnostic codes are extracted form these polices and combined with our own proprietary NMD (National Medicare Database) crosswalks based on millions of validated medical claims. Policies and Article contain reasonable and necessary conditions of coverage and other information such as coding and payment guidelines. In addition to lists of ICD10 diagnostic codes that support medical necessity many policies contain lists of ICD10 codes that do not support medical necessity.

CrossCoder allows lookup for over 16,000 medical service/procedure codes including CPT, HCPCS Level II, DMEPOS, J Codes, Anesthesia, Category II and III ( F and T codes) and over 94,000 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 5.2 million crosswalks. The Professional Version exports these crosswalks to CSV (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 wherever possible.

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 medical procedure or service the claim will be rejected causing 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 use 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 Windows PC 7/8/10

For additional information see our FAQ page.

CrossCoder is based on 3 sources.

Local 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.

Local Coverage Article (LCA):

A local policy may consist of two separate, though closely related documents: the LCD and an associated Article (LCA). The LCD only contains reasonable and necessary language. Any non-reasonable and necessary language a Medicare contractor wishes to communicate to providers may be done through the Article.

National Medicare Database (NMD):

NMD Crosswalks are based on our independent analysis of over 40,000,000 validated claims. This additional source of crosswalks information greatly helps locate and validate medical necessity for thousands of procedures and services codes not found in LCD and NCD policies.