• SMM Coding Services: SMM will provide coding services including CPT-4 procedure codes, CPT-4 modifiers, and ICD-9 diagnosis codes. All coding will address compliance with the coding and billing guidelines established by the Centers for Medicare and Medicaid Services (CMS), the American Medical Association (AMA), and with the Documentation Standards for Radiological Studies as developed by the American College of Radiology (ACR). CMS’ National Correct Coding Initiative (NCCI) edits will also be referenced in coding these services, to assure that unbundling does not occur. SMM will assign codes based solely on the specific documented information contained within the typewritten radiology report supplied by Client. Coding will be performed only by SMM employees currently maintaining a national coding certification and having diagnostic and interventional radiology coding experience. Client will be consulted regarding missing, conflicting, or ambiguous documentation within the report, in accordance with SMM’s Compliance Plan.
     
  • Process Client shall provide SMM with typewritten radiology reports via paper or electronic means. All paper reports shall be shipped directly to SMM’s office via a national delivery service, where they will be coded and returned to Client via a national delivery service within an agreed upon time frame. Client is responsible for all delivery costs. All electronically submitted reports will be coded and returned to Client via same electronic means within an agreed upon time frame. Client is responsible for all costs associated with providing SMM with electronic access to their reports. Any reports not containing sufficient information regarding the medical necessity of the study or sufficient documentation of the study itself will be returned to Client uncoded, in accordance with SMM’s Compliance Plan.
     
  • Compliance SMM will code procedures in accordance with all applicable federal rules, regulations and guidance, as stated above. SMM reserves the right to comply with the recommendations of the Office of Inspector General in its Compliance Guidance for Third Party Billing Companies. SMM will perform all coding services in accordance with SMM’s Compliance Plan.