AUC Medical Code TAG

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For Minnesota Statutes 62J.536 project: Create common standards in cases where Medicare does not meet Minnesota needs and Minnesota commercial health plan group purchasers require providers to code medical services differently, depending upon the group purchaser.

An overarching principle of this work is the fact that, each MN group purchaser and provider will be required to make changes to procedures, policies and/or systems in some way, as a result of the work of the AUC and the Medical Code TAG.

Determine scope and relevance to Medical Code TAG for Minnesota Statutes 62J.536 project:

• The Medical Code TAG typically addresses issues such as:
  • HCPCS Codes (CPT Codes)
  • Revenue Codes
  • Modifiers
  • Units – e.g., bilateral procedures, anesthesia
• Items not within the above Scope of the Medical Code TAG will be forwarded on to the appropriate AUC TAG, e.g., Claims Data Definitions for resolution. The Medical Code TAG will bring any items with unknown ownership to the AUC Executive Committee.

• For each coding topic the Medical Code TAG will first review the CMS Online Medicare Claims Processing Manual and if group purchasers/providers agree with Medicare no further action is required.
• If group purchasers/providers do not agree to follow Medicare, or Medicare guidance is not provided, the Medical Code TAG will review appropriate materials and determine uniform coding. The Medical Code TAG will continue to address new code standards using the above processes.

Minnesota rules for uniform coding when group purchasers/providers use codes other than those in the CMS Online Medicare Claims Processing Manual will be in an appendix to the:

• MN Institutional Claims (837I) Companion Guide
• MN Professional Claims (837P) Companion Guide
• MN Dental Claims (837D) Companion Guide
• MN Pharmacy Claims (NCPDP 5.1) Companion Guide

The Medical Code TAG also maintaining the MN Community Coding Practice/Recommendation Table. The Table:

• Provides clarification and answers to frequently asked questions about recommended ways to code for health and medical services on the 837I and 837P electronic claim
• Is intended for use in conjunction with "Appendix A, Table A.5.1" of the "Minnesota Uniform Companion Guides for the 837 Institutional (I) and 837 Professional (P) transactions"

01/01/2007 (Formerly State HCPCS Committee)

Revised: 8/8/13