CrossCoder 2005

CrossCoder™ is your low cost Windows solution for finding "crosswalks" between CPT® Codes and ICD Codes.

A "crosswalk" or "link" refers to a relationship between a Medical Procedure (CPT Code) and a Diagnosis (ICD Code).

Medicare uses CPT Code/ICD Code crosswalks to validate or substantiate medical necessity based on Local Coverage Determinations (LCD). Private payers also establish crosswalk tables for validating and auditing medical claims.

In brief, physicians are paid by CPT procedure code not 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 may not get paid.