CPT coding is much more complex than simply inputting codes into a system. There are lots of things that CPT coders have to keep in mind when using their HIPAA compliant medical billing software. Skilled coders make sure they avoid certain behaviors that could create errors and or cause an audit to occur. Knowing what to avoid is just as important as knowing what to do, when it comes to CPT coding.
If there were an audit of different medical offices, one thing would be abundantly clear: code 99213 is a favorite for physicians and medical billers. This is considered to be a safe code. The idea is the price point isn’t too high to cause red flags but it is also isn’t so low that the facility will lose money. However, a lot of facilities do actually lose money with their medical billing when they overuse this code. In addition, overusing a single code can lead to an audit. If coders find out they are using code 99213 too much, it is time to regroup and come up with another strategy, can start inputting the correct visit codes into their HIPAA compliant medical billing software.
CPT coding is an ever-changing profession. Codes are updated regularly. If a coder uses an old book, they will likely use medical billing codes that are no longer in use. That means the codes that go into the HIPAA compliant medical billing software will be wrong. CPT coding professionals should have the current information as soon as it is released. In addition, they should read the editorial comments at the beginning of each section of the CPT coding book. The comments will answer questions and help the coder make sound decisions.
Modifier 25 is one of the most misused codes and is often the cause of an audit. Modifier 25 should only be used if a patient receives a significant E/M service that is separately identifiable from the procedure they came in for. It also must be done on the same day by the same physician. Otherwise, Modifier 25 should not be entered into the medical billing system.
HIPAA compliant medical billing software takes a lot of the hard work out of medical coding. Still, CPT coding professionals need to avoid certain behaviors so they do not put their practices at risk. Avoiding these behaviors will also make the medical billing process go more smoothly.