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CrossCoder for Medical to Diagnosis Code Crosswalks

Lookup CPT® 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.

FREE DEMO Standard Version Only $249! Professional Version (includes exporting privileges) $999

CrossCoder is your low cost Windows solution for finding “crosswalks” or links between CPT® /HCPCS procedure and service codes with supporting ICD10 diagnostic codes. A “crosswalk” or “link” refers to a relationship between a Medical Procedure (CPT/HCPCS Code) and a Diagnosis (ICD10 Code).

Medicare 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 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 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 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.

CrossCoder has two versions: Standard ($249) and Professional ($999). The CrossCoder Professional Version provides users with full exporting privileges.

For additional information see our FAQ page.

CrossCoder is based on 3 sources:

  • National 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.
  • 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.
  • National Medicare Database (NMD): Ccrosswalks based on an independent analysis of CMS’ LDS data files containing millions of validated claims.

For Windows PC 7/8/10/11