In reading some posts in the forum, it looks like several people have commented that they have received denials from Medicare for smoking cessation counseling and that it was likely due to the Dx codes, specifically the F17.20 - F17.299 codes. Was a quit date set? Any suggestions as to what modifier I should be using? All our content are education purpose only. It may not display this or other websites correctly. Modifier Lookup Tool. CPT Codes, Descriptors, and other data only are copyright 1999 American Medical Association (or such other date of publication of CPT). What you need to know about CPT Codes 99453, 99454, and 99457 . Medicare covers 2 cessation attempts per year. Medicare Part B already covers cessation counseling for individuals who: 1. Each attempt may include a maximum of four intermediate or intensive counseling sessions. Contractors shall allow payment for a medically necessary E/M service on the same day as the smoking and tobacco-use cessation counseling service when it is clinically appropriate. This modifier should be used in exceptional cases only, and payors will frequently require documentation of the service before they make payment. And preventing illness or injury 99406 Smoking and tobacco use cessation counseling visit ; intermediate greater. A patient requests an initial appointment for assistance with depressive symptoms and interpersonal difficulties. Can you escalate to your provider rep, if you have one? CPT codes All Rights Reserved to AMA. An initial treatment plan is agreed upon, and the first psychotherapy session is scheduled for later that week. Do I have that right? 99407 Smoking and tobacco use cessation counseling visit; intensive, greater than 10 minutes -Avreage fee amount- $25 $30. 3>. Counseling involving only 1 session lasting less than 3 minutes is considered part of an E/M service and is not reimbursed separately. registered for member area and forum access. . National Institutes of Health State-of-the-Science conference statement: tobacco use: prevention, cessation, and control. Like CPT, it includes three levels or categories of codes: 1. By entering the beneficiarys health insurance claim number (HICN), providers have the capability to view the number of sessions a beneficiary has received for this service via inquiry through CWF. office manager or physician? These handy quick reference sheets included at-a-glance MDM requirements for office, hospital, nursing home and home and residence services. 99397 and additional screening codes 99406-99409 and 96160) when reported in conjunction with immunization administrative services (90460-99474) . CPT 91311, 0111A, 0112A Covid Vaccine for children, 5 Important points to improve claim submission success rate. This tool is intended to assist suppliers in determining potential modifiers that may be used in billing DMEPOS HCPCS codes. Assessed willingness to attempt to quit. Optum will align reimbursement with Medicare including up to 2 attempts of up to 4 sessions each for a total of up to 8 face-toface visits during a 12-month period for individuals who use tobacco regardless of whether there are signs or symptoms of tobacco-related disease. "13012p]8? Your patient then transitions to tobacco quitline support and tells you they are no longer smoking at their regular session 12 weeks later. Minimal counseling3> The NSDUH Report: Adults With Mental Illness or Substance Use Disorder Account for 40 Percent of All Cigarettes Smoked [PDF563 KB]. These are in addition to the two CPT Codes 99406 and 99407 that currently are used for tobacco cessation counseling for symptomatic individuals. They are being replaced by two new CPT codes (99406 Smoking and tobaccouse cessation counseling visit; intermediate, greater than 3 minutes up to 10 minutes; and 99407 Smoking and tobacco-use cessation counseling visit; intensive, greater than 10 minutes). Use existing CPT codes 99406 and 99407 for smoking and tobacco-use cessation counseling visits. Finding Medicare fee schedule HOw to Guide, Gastroenterology, Colonoscopy, Endoscopy Medicare CPT Code Fee, LCD and procedure to diagnosis lookup How to Guide, Medicare claim address, phone numbers, payor id revised list, Medicare Fee for Office Visit CPT Codes CPT Code 99213, 99214, 99203. Reply. All our content are education purpose only. The following ICD-10-CM codes support medical necessity and provide coverage for CPT/HCPCS codes: 95800, 95801, 95806, G0398, G0399 and G0400. You must log in or register to reply here. Whose counseling is furnished by a qualified physician or other Medicare-recognized practitioner. Claims without the AT modifier will be . Also, I read that the G codes for Medicare were deleted several years ago and were replaced with 99406-99407; same codes as commercial payers. C9801: Smoking and tobacco cessation counseling visit for the asymptomatic patient; intermediate, greater than 3 minutes, up to 10 minutes, Short descriptor: Tobacco-use counsel 3-10 min, C9802: Smoking and tobacco cessation counseling visit for the asymptomatic patient; intensive, greater than 10 minutes. People with behavioral health conditions who smoke cigarettes are four times more likely to die prematurely than those who do not smoke. Recent advocacy efforts by APA Services resulted in changes in NCCI edits which now allow psychologists to report smoking and tobacco use cessation counseling services (CPT codes 99406 or 99407) when performed at the same encounter as an individual psychotherapy session (codes 90832, 90834, and 90837). Only one of the codes should be reported on a claim form, depending on the amount of time that was spent performing the counseling visit. Manny Oliverez. Medicare Summary Notices (MSNs), Remittance Advice Remark Codes (RARCs), Claims Adjustment Reason Codes (CARCs), and Group Codes, (Rev. CPT Modifier 57 This modifier should not be submitted with E/M codes that are explicitly for new patients only: Use of modifiers Whose counseling is furnished by a qualified physician or other Medicare-recognized practitioner. CPT. Good Morning fellow coders, I would like to know your thoughts on billing 99406 (Smoking Cessation counseling 3-10 Min) when billing as an example the following codes today. 7133-04.4.2 CWF shall deny counseling to prevent tobacco use services (HCPCS G0436, G0437, 99406, 99407) that exceed a combined total of 8 sessions within a 12-month period. 99406 and 99407 are the remaining codes for tobacco cessation counseling. Medicaid Services, as well as other payers. Copyright American Medical Association. 99407: Smoking and tobacco use cessation counseling visit; intensive, greater than 10 minutes. The diagnosis codes that should be reported for individuals who do not have signs or symptoms of tobacco-related disease individuals are: ICD-9 code 305.1 (non-dependent tobacco use disorder), ICD-9 code V15.82 (history of tobacco use), Minimal counseling (<3 e="" in="" included="" is="" minutes="" p="" service.="" the=""> All our content are education purpose only. Intermediate counseling is 2 to 3 sessions of 3 to 10 minutes each. There are two codes used to report counseling by a physician or non-physician practitioner (NPP) with the patient for smoking cessation. From reading the policy for Amerigroup - Policy to procedure - it almost sound like they want one of these modifiers, but their definitions are not for a regular mds doing E/M visits. CPT Manual defines modifier 59 as a "Distinct Procedural Service." The 59 modifier is considered the most misused modifier by coders. If you also report an E/M, then the 25 modifier would go on the E/M. CPT is a registered trademark of the American Medical Association. Optum will align reimbursement with Medicare including 2 cessation attempts per year. All Rights Reserved to AMA. They will be denied IN (service incidental to primary procedure, no patient liability) with all other E/M services. I have been having an issue getting paid by UHC Americhoice and dual complete for both my smoking cessations and vaccines. How to TRANSITIONING/TRANSFERRING OF ENROLLEES to MCO, What is Patient driven Grouping model how its working, Workers Compensation Medicare Set-Aside Arrangement (WCMSA) Full coverage, Understanding Medicare cost Reports and usage. They will appear in the quarterly coding updates for October 2010, and the TOS code is 1. Physicians and qualified non-physician practitioners shall use an appropriate HCPCS code to report an E/M service with modifier -25 to indicate that the E/M service is a separately identifiable service from G0436 or G0437. These new CPT codes, which are included in the 2008 Medicare Physician Fee Database (MPFSDB), become effective for claims with dates of service January 1, 2008 and later. Some procedures do not need further clarification with a modifier. 99406: Smoking and tobacco use cessation counseling visit; intermediate, greater than 3 minutes up to 10 minutes 99407: Smoking and tobacco use cessation counseling visit; intensive, greater than 10 minutes Per CCI the 99495 or 99496 cannot have a modifier 25 appended, which may be a hint that it is intended to be billed alone. Contractors shall use Group Code CO, assigning financial liability to the provider, if a claim is received with no signed ABN on file. Amerigroup has been unable to tell you specifically which policy they are applying to your claim? These are in addition to the two CPT codes 99406 and 99407 that currently are used for tobacco cessation counseling for symptomatic individuals. The beneficiary may receive another 8 sessions during a second or subsequent year after 11 full months have passed since the first Medicare covered counseling session was performed. determine the appropriate submission codes for covered preventive services. C9801 Smoking and tobacco cessation counseling visit for the asymptomatic patient, intermediate, greater than 3 minutes, up to 10 minutes Short descriptor: Tobacco-use counsel 3-10 min, C9802 Smoking and tobacco cessation counseling visit for the asymptomatic patient, intensive, greater than 10 minutes. G0437: Smoking and tobacco cessation counseling visit for the asymptomatic patient; intensive, greater than 10 minutes The ICD-10 codes diagnosis codes that should be reported for individuals who do not have signs or symptoms of tobacco-related disease individuals are: [MLN, 2015], F17.200: Nicotine dependence, unspecified, uncomplicated If you are a member and have already registered for member area and forum access, you can log in by clicking here. | G0438, Age and wellness visits | Eligibility for Welcome to Medicare, Smoking and tobacco use cessation counseling visit; intermediate, greater than 3 minutes up to 10 minutes. The beneficiary The CPT codes are listed below for billing for smoking cessation: 99406 - Smoking and tobacco use cessation counseling visit; intermediate, greater than 3 minutes up to 10 minutes 99407 - Smoking and tobacco use cessation counseling visit; intensive, greater than 10 minutes A modifier 25 may be appropriate to append to the primary E/M visit code. Probably the only X modifier to use would be the XU and that's basically like reporting the 59 modifier. Short descriptor: Tobacco-use counsel >10min During the same interim period of time between August 25, 2010, and December 31, 2010, carriers shall pay claims for these tobacco-cessation counseling sessions with unlisted code 99199. F17.291: Nicotine dependence, unspecified, in remission The following HCPCS codes should be reported when billing for counseling to prevent tobacco use services: 99406 - Smoking and tobacco-use cessation . If other providers have also billed for cessation your patient could have hit the maximum for the year. Deductible and coinsurance will apply in a standard medical benefit. Beginning January 1, 2023 there are two Read More All content on CodingIntel is copyright protected. If the member has the preventive medical benefit, the deductable and coinsurance will not apply, and any diagnosis code will also apply. CPT 1003F allows when billed with modifier SE Each attempt may include a maximum of four intermediate or intensive counseling sessions. . Its complete definition, defined by the American Medical Association Current Procedural Terminology 2012, is "a significant, separately identifiable E/M service by the same physician on the same day of the procedure or other service. For more information, please visit the National Native Networks Keep it Sacred website. HCPCS/CPT Codes: 99406 - Smoking and tobacco-use cessation counseling visit; intermediate, greater than three . Counseling involving only 1 session lasting less than 3 minutes is considered part of an E/M service and is not reimbursed separately. If you check the CCI edits, you'll see that 99406 is a Column 2 code when billed with 90471. Ann Intern Med. Sign up for Betsys monthly newsletter to download these reference sheets and share them with your practitioners. The new G codes for use on claims with dates of service on or after January 1, 2011 are: Note also the following claims processing information from CR 7133: Claims submitted with the tobacco cessation counseling codes of G0436 and G0437, but which lack a required diagnosis code (305.1 or V15.82) will be denied with Claim Adjustment reason Code (CARC) 167 (This (these) diagnosis (es) is (are) not covered. If this is your first visit, be sure to check out the. Expert Answers: Key point to remember! American Psychological Association. Code 99406 is a column 2 code for 90471, but you may use a CCI-associated modifier to override the edit under appropriate circumstances. 99217 Observation care discharge day management (This code is to be utilized to report all services provided to a patient on discharge from outpatient hospital "observation status" if the discharge is on other than the initial date of "observation status." To report services to a patient designated as "observation status" or "inpatient status" and . Diagnosis codes should reflect: the condition the patient has that is adversely affected by tobacco use or the condition the patient is being treated for with a therapeutic agent whose metabolism or dosing is affected by tobacco use. Our billing service specializes in utilizing the most accurate add-on and modifiers with your routine codes to ensure your claims are safely maximized. Each attempt may include a maximum of 4 intermediate or intensive sessions, with the total Has anyone had success with these codes? a CodingIntel membership, Last revised January 5, 2023 - Betsy Nicoletti Tags: screening and counseling for behavioral conditions. Services may be provided by a physician, physician assistant, nurse practitioner, clinical nurse specialist, qualified psychologist or clinical social worker. (Use for children and adolescents ages 10 up to 21).o 649.03 Tobacco use disorder complicating pregnancy, childbirth or the puerperium antepartum. Two cessation attempts per year. On January 3, 2011, contractors systems will accept the new G codes for services performed on or after August 25, 2010. Inpatients are covered only if counseling for tobacco use is not the primary reason for the patients hospital stay. Centers for Disease Control and Prevention P, Centers for Medicare and Medicaid Services:National Coverage Determination (NCD). f(aAV2*%X-Pi/[ .!<2H=hM-AMGx6Pc@vAv]i`)w+L;N 3O}C',sxt@c<0C. - these 2 CPT Codes 20552, 20553 DO NOT NEED A MODIFIER! 99408 - CPT Code in category: Alcohol and/or substance (other than tobacco) abuse structured screening (eg, AUDIT, DAST), and brief intervention (SBI) services CPT Code information is available to subscribers and includes the CPT code number, short description, long description, guidelines and more. HCPCS codes for tobacco cessation counseling for asymptomatic individuals are: G0436: Smoking and tobacco cessation counseling visit for the asymptomatic patient; intermediate, greater than three minutes, up to 10 minutes, G0437: Smoking and tobacco cessation counseling visit for the asymptomatic patient; intensive, greater than 10 minutes Minimal counseling (<3 -25="" a="" and="" appended="" applicable="" as="" be="" cessation="" code="" counseling="" cpt="" date.="" distinct="" e="" either="" hcpcs="" is="" minutes="" modifier="" not="" on="" or="" p="" reimbursable="" reporting="" same="" separate="" service.="" service="" should="" the="" to="" tobacco="" when=""> The diagnosis codes that should be reported for these individuals are ICD-9 codes 305.1, nondependent tobacco use disorder, or V15.82, history of tobacco use. Tobacco cessation therapy services may be billed in conjunction with the appropriate evaluation and management office visit code when medically necessary. Codes . Medical coding resources for physicians and their staff. Provide cessation interventions to persons who use commercial tobacco: For nonpregnant adults, provide behavioral counseling for cessation: Effective behavioral counseling interventions include provider advice, individual counseling, group behavioral interventions, telephone counseling, and mobile phonebased interventions. Healthcare Common Procedure Coding System (HCPCS) and Diagnosis Coding (Rev. RARC N362: The number of days or units of service exceeds our acceptable maximum. Contractors shall use Group Code PR, assigning financial liability to the beneficiary, if a claim is received with a signed ABN on file. The total session lasted 60 minutes with 54 spent addressing the patients depressive symptoms and six focused on smoking cessation. So the combination 99396-25 and 99495 may well be acceptable. Addressing barriers to change and ways to avoid relapse. The diagnosis codes that should be reported for these individuals are: The CMS has created two new G codes for billing for tobacco cessation counseling services to prevent tobacco use for dates of service on or after January 1, 2011. The counseling during an E/M service must be either intermediate or intensive. Telephone codes 99441-99443 require audio only but will pay at the rates of 99212-99214. C>w\1S6{[vEm~S2rNiS^pI:~/I (:Mi dTx243:!1 RU copayment is waived for CPT codes 99406 and 99407. Do not report 99406 for less than three minutes of service. For a better experience, please enable JavaScript in your browser before proceeding. 99407 Smoking and tobacco-use cessation counseling visit; intensive, greater than 10 minutes. Then, for seven additional minutes you use an ACT-informed approach to support the patient with their expressed desire to quit. i Centers for Disease Control and Prevention. 99406 Smoking and tobacco-use cessation counseling visit; intermediate, greater than 3 minutes up to 10 minutes, 99407 Smoking and tobacco-use cessation counseling visit; intensive, greater than 10 minutes, F17.200, F17.201, F17.210, F17.211, F17.220, F17.221, F17.290, F17.291, T65.211A, T65.212A, T65.213A, T65.214A, T65.221A, T65.222A, T65.223A, T65.224A, T65.291A, T65.292A, T65.293A, T65.294A, and Z87.891. Vital Signs Fact Sheet: Adult Smoking Focusing on People With Mental Illness, February 2013. Level I: This matches the AMA's CPT numeric codes. CWF shall deny counseling to prevent tobacco use services (HCPCS G0436, G0437, 99406, 99407) that exceed a combined total of 8 sessions within a 12-month period. Fact Sheet: The Tobacco Epidemic Among People With Behavioral Health Disorders. While assessing the patients health history, they report using commercial tobacco, smoking 1015 cigarettes each day. CPT code 99453 is a one-time billing code that is used when a patient initially enrolls into a remote monitoring program at the recommendation of a physician or qualified healthcare professional (QHP). Use of modifiers other . 99406: Smoking and tobacco use cessation counseling visit; intermediate, greater than 3 minutes up to 10 minutes, 99407: Smoking and tobacco use cessation counseling visit; intensive, greater than 10 minutes They arent opposed to talking about their smoking but really want to focus first on a plan to address their presenting problems. (visits do not need to be 12 months apart) G0438* (first visit) G0439* (subsequent visit) . Effective January 1, 2016, use CPT code 81528 when billing for the Cologuard test (note that your MAC will accept HCPCS code G0464 for claims with dates of service on or before December 31, 2015). CPT 99401 must be reported with modifier CR; if not reported, will deny. Short descriptor: Tobacco-use counsel >10min Claims for smoking and tobacco use cessation counseling services G0436 and G0437 shall be submitted with diagnosis code V15.82, history of tobacco use, or 305.1, non-dependent tobacco use disorder. These are in addition to the two CPT Codes 99406 and 99407 that currently are used for tobacco cessation counseling for symptomatic iindividuals. They will appear in the quarterly coding updates for January 2011 and the TOS code is 1. You provide them with a brochure for your states tobacco quitline and let them know they can call anytime for support. It's free to sign up and bid on jobs. When performed on the same date of service as a psychotherapy session, Modifier 59 will be needed to indicate that Smoking and Tobacco Use Cessation Counseling was an independently performed service. As the first session nears the 45 minute mark, the patient again shares that they often step outside for a smoke after arguments at home, and that it leaves them more depressed after the buzz wears off. You ask if they would be open to using some session time to explore their smoking and they agree. 1/j,Q}"5iKW; Inpatients are covered only if counseling for tobacco use is not the primary reason for the patients hospital stay. This is just a regular medical clinic that does office visits. Facilities should report the service on a UB-1450 form utilizing bill type 12X, 13X, 22X, 23X, 34X, 71X, 73X, 83X, or 85X with reimbursement mapping to the correct method of payment (usually the outpatient facility fee schedule). The link to the policy for UHC they keep pointing me to is. I changed from UHC Americhoice to Amerigroup midpost. January 15, 2023 September 21, 2022 by Alexander Johnson. 99407. ntensive, greater than 10 minutesi. The first modifier to consider is 25. They are being replaced by two new CPT codes (99406 Smoking and tobaccouse cessation counseling visit; intermediate, greater than 3 inutes up to 10. *APA acknowledges and honors the importance of the role served by traditional tobacco for many tribes. The modifier provides additional information about the medical procedure, service, or supply involved without changing the meaning of the code. Claims are accepted for G0436 and G0437 with revenue code 052X when billed on TOBs 71X or 77X. hT_HSQ:ui;IE,y+OaC)S70((I-!H,5`O!f=u])c}| >09h`q`b -'V-Q;zVU+8Z{?Bra|};2:k0;}Z ip`>UOtmGf3}7]VFK9 PZK}0,ZFrR1gOeE\]0s-s:5l.Aj[KnX'lO$]V#{dR_7mtVRjk\YJ 7bp.We($)6^BZ The Common Working File (CWF) maintains the number of smoking and tobacco-use cessation counseling sessions rendered to a beneficiary. You are using an out of date browser. By entering the beneficiarys health insurance claim number (HICN), providers have the capability to view the number of sessions a beneficiary has received for this service via inquiry through CWF. Does CPT code 98940 need a modifier? 99407 is not an add-on code, and the two codes are never reported together. It appears as if they can be stand alone codes. Effective for services on or after January 1, 2008, you must bill for smoking and tobacco use cessation counseling services with new CPT codes (99406 or 99407). All Rights Reserved to AMA. Additional injectable immunization administrations are billed with CPT code 90472 . NOTE: In calculating a 12-month period, 11 months must pass following the month in which the 1st Medicare covered cessation counseling session was performed. Does the policy you have support that? If this is your first visit, be sure to check out the. How to TRANSITIONING/TRANSFERRING OF ENROLLEES to MCO, What is Patient driven Grouping model how its working, Workers Compensation Medicare Set-Aside Arrangement (WCMSA) Full coverage, Understanding Medicare cost Reports and usage. which insurance is primary. JavaScript is disabled. Effective January 1, 2010, Medicaid will cover smoking cessation counseling during a medical visit to pregnant and postpartum women and children and adolescents ages 10 to 21. 99406- smoking cessation >3 min. NOTE: In calculating a 12-month period, 11 months must pass following the month in which the 1st Medicare covered cessation counseling session was performed. JavaScript is disabled. number of counseling attempts the patient has received from other providers) within the preceding 12-month period to ensure claims are not denied due to exceeding the individual patient frequency limit. 99406 Smoking and tobacco use cessation counseling visit; intermediate, greater than 3 minutes up to 10 minutes 99407 Smoking and tobacco use cessation counseling visit; intensive, greater than 10 minutes The National Correct Coding Initiative (NCCI) is a program developed by the Centers for Medicare and Medicaid Services (CMS) to promote correct coding methodologies and to control improper coding that leads to inappropriate payment of claims. ), Remittance Advice Remarks Code (RARC) M64 (Missing/incomplete/invalid other diagnosis), and Group Code PR assigning financial liability to the beneficiary if a claim is received with a signed Advance Beneficiary Notice (ABN). CPT Code Description. Reimbursement for smoking cessation counseling (SCC) must meet the following criteria: Services must be provided face-to-face. ONLY available for Medicaid-eligible pregnant females, women up to 6 months postpartum, and children and adolescents ages 10-21 who smoke. The total annual benefit is for 8 sessions in a 12 month period. The CMS has created two new G codes for billing for tobacco cessation counseling services to prevent tobacco use. The patient must be competent and alert at the time that counseling is provided. It may not display this or other websites correctly. CR 5878, from which this article is taken announces that the temporary HCPCS G codes G0375 and G0376, which are currently used to bill for Smoking and Tobacco Use Cessation Counseling services, are effective only through December31, 2007. Our mission is to provide up-to-date, simplified, citation driven resources that empower our members to gain confidence and authority in their coding role. All the articles are getting from various resources. Copyright 2023, CodingIntel Level II: These are alphanumeric and include items not covered by CPT-4 codes, including non-physician services such as ambulance, prosthetic devices, items and supplies. ), RARC N362 (The number of days or units of service exceeds our acceptable maximum. Freelancer Medicare and most private insurers pay for physicians, NPs and PAs to counsel patients regarding smoking cessation. Outpatient and hospitalized Medicare beneficiaries for whom all of the following are true: * Use tobacco, regardless of whether they exhibit signs or symptoms of tobacco-related disease, * Competent and alert at the time of counseling, * Counseling furnished by a qualified physician or other Medicare-recognized practitioner. April 21st, 2019 - Does anyone here have access to Revenue Code crosswalk tools like Uniform Billing Editor or Revenue Cycle Pro I need a help with 6 codes . maximum for this time period or occurrence has been reached. The counseling must be provided face-to-face with the patient. I so sorry it took me a minute to get back to this. NOTE: Contractors shall apply contractor-pricing to claims containing HCPCS G0296 and G0297 with dates of service February 5, 2015, through . The counseling must be provided face-to-face with the patient. Contractors shall use Group Code PR, assigning financial liability to the beneficiary, if a claim is received with a signed ABN on file. When medically indicated, this additional E/M service is subject . CPT Add-On Code +99354 Reimbursement Rate (2022): $ 140.26 Additional time up to 1 hour and 45 minutes for a diagnostic interview CPT Add-On Code +99354 Reimbursement Rate (2020): $132.09 Patient has WC and Medicare insurance? A total of eight sessions are covered in a 12-month period. These are in addition to the two CPT codes 99406 and 99407 that currently are used for tobacco cessation counseling for symptomatic individuals. (2022, September 9). F17.290: Nicotine dependence, chewing tobacco, uncomplicated (Use for pregnant women who smoke).o 649.04 Tobacco use disorder complicating pregnancy childbirth or the puerperium postpartum. Also I would bill out the 99214 with the modifier -25 if also billing out for the 99406. The revenue codes and UB-04 codes are the IP of the American Hospital Association. These medical records can be used in any post-payment reviews and must include standard information along with sufficient patient histories to allow determination that the steps required in the coverage instructions were followed.