Accurate medical coding is crucial for healthcare providers, especially in long-term care (LTC) settings. To ensure correct billing and reimbursement for services, it’s essential to use the appropriate coding resources. For Texas Long-term Care providers, resources like bill code crosswalks are vital tools that link local Texas LTC codes to national standard procedure codes. These crosswalks, such as the Long-term Care Bill Code Crosswalk, updated December 19, 2024, are designed to help providers translate their internal billing codes into universally recognized codes needed for claims processing.
Specifically, these crosswalks match Texas Long-term Care Local Codes with National Standard Procedure Codes, including procedure, item, and revenue codes. Providers must refer to these documents, particularly the Long-term Care Bill Code Crosswalk associated with the billed service, when submitting claims for payment. This ensures that the services provided are accurately represented using Healthcare Common Procedure Coding System (HCPCS) codes and modifiers, as required for Medicaid payment.
For Home and Community-based Services (HCS) and Texas Home Living (TxHmL) providers, there are specific crosswalks available. The Home and Community-based Services (HCS) and Texas Home Living (TxHmL) Bill Code Crosswalk, updated December 1, 2015, is for claims with Dates of Service (DOS) up to April 30, 2022. For DOS beginning May 1, 2022, providers should use the HCS and TxHmL Bill Code Crosswalk, updated December 19, 2024, when submitting claims through TMHP TexMedConnect or Electronic Data Interface (EDI).
It’s important to note that the effective date for the latest bill code crosswalk is May 1, 2022. The Texas Medicaid & Healthcare Partnership (TMHP) Claims Management System uses this crosswalk for claims with DOS May 1, 2022, and later. Furthermore, all HCS/TxHmL Adaptive Aids, Dental, and Minor Home Modification bill codes, which were previously submitted manually, are now included in these crosswalks to facilitate automated claim submissions.
For services relevant to Electronic Visit Verification (EVV), providers can find a crosswalk in the Service Bill Codes section on the EVV page, which covers Long-Term Care, Acute Care, and Managed Care programs. Using the correct HCPCS and modifier combinations from the EVV Services table is critical to avoid EVV visit transaction rejections and claim denials. By utilizing these detailed bill code crosswalks, medical coding for long-term care services can be streamlined and made more accurate, ensuring proper reimbursement and compliance.
