Suppose you’re a Physician Assistant, and at the end of the visit with your patient who has a Chronic Obstructive Pulmonary Disease exacerbation, and you’ve sent her prescriptions to her local pharmacy. You know you will use the ICD-10 diagnosis code of J44.1, but since you spent a great deal of time evaluating her peak flow, pulse ox, and whether she needs to be admitted to the hospital, you can’t decided if you should bill this visit as a 3 or a 4? Will any of the sputum samples you collected require a CPT modifier?
Current Procedural Terminology codes, or CPTs, are codes corresponding to medical, surgical, or diagnostic procedures or services, used by medical providers, health insurance companies, or accreditation services. In the process of medical billing, CPT codes are used in conjunction with ICD-10 Diagnosis Codes to successfully bill for a medical encounter.
Categories of CPT Codes
Category 1 CPT Codes
There are three categories of CPT codes. Category 1 CPT codes are five-digit codes assigned to widely performed medical services and procedures that are fully approved by the FDA. Category 1 CPT codes can be sub-divided into the six subcategories of medicine, surgery, radiology, anesthesiology, pathology, and evaluation/management.
Category 2 CPT Codes
Category 2 CPT codes are supplemental codes that describe performance measures and the quality of medical care delivered. They are often seen as optional adjuncts to Category 1 CPTs, as they can’t be used on their own.
Category 3 CPT Codes
Category 3 CPT codes are often changing, temporary codes for emerging medical technologies, novel procedures, and innovative services. They correspond to procedures that might not be fully FDA approved but are often part of ongoing research. Category 3 CPT use is seen as a way to track these new treatment modalities.
To ICD or Not?
If you’re a medical provider or work in any type of medical billing, you might already know the main difference between CPT and ICD-10 codes: CPTs code for procedures, and ICDs code for diagnoses. In general, ICDs don’t change often, while CPTs are made to be constantly revised. Simple, right?
What if you perform an abdominal paracentesis procedure that is both therapeutic and diagnostic? How does one accurately CPT and ICD code for that? After the laboratory results come back and a diagnosis of spontaneous bacterial peritonitis is established, do your previous codes need to be modified or amended?
Or how about CPT codes for initial versus established patients? If you are a medical provider examining a patient previously seen by a partner in your practice three and a half years ago, do you code the visit as an initial or established patient visit? Do you know what the minimum number of minutes required to bill for a family psychotherapy CPT based on the most recent 2017 guidelines?
Call the Experts
If CPT coding itself, or CPT combined with ICD-10 coding feels labyrinthine, you aren’t alone. If you don’t know the answers to these questions off the top of your head, or if you are a practice manager who knows just how complicated these matters can get, there is a preferred solution. By outsourcing your medical billing and CPT coding instead of keeping it all in-house, you can be assured your practice is CPT coding correctly, that your office is billing accurately, and that your medical services are better reaching their intended revenue targets. The numerous benefits of letting expert medical coders handle your CPTs include but are not limited to:
More Accurate Medical Billing to the Patient
Even with the most competent in-house billing departments, estimates of up to 80 percent of medical bills sent to patients contain print errors, often exacerbated by the confusion that CPT codes can elicit in patients. Outsourcing this task often simplifies the coding information for patients and allows for a smoother billing and claims process.
Healthcare practices can often form personal relationships with the companies to which they outsource their medical coding. This means if a practice has a preference to code certain procedures (or diagnoses) in a specific way, the medical coding service can tailor their work accordingly.
The most difficult task with medical coding is staying up-to-date with the newest rule changes or CPT coding strategies. Staying up-to-date is especially difficult for an in-house billing department already stretched thin with other business administrative tasks. Outsourcing CPT coding has a baked-in guarantee that the coders are completely up-to-date and won’t need to take time off for the latest training.
Category 3 Changes
Are you worried you won’t be able to keep up with the constantly changing Category 3 CPT experimental procedure codes? You shouldn’t. Instead, medical billing outsourcing firms watch these changes professionally and in some cases, can help predict which changes are on the horizon.
Medical billing companies can handle CPTs in every aspect of the billing process, from managing information related to add-on medical procedures to processing payments received from insurance companies for services rendered.
Partner with a Professional Outsourced Medical Billing Team
These aren’t the only advantages of outsourcing your medical billing and CPT coding to a medical billing firm like Delphi Management Services. Knowing you have a team of experts sorting out the complicated web of medical billing to greatly increase your practice’s business efficiency is usually reward enough. Knowing experts will have you covered when it comes to CPTs, and that you can spend more time on patient care, makes outsourcing your medical billing that much more attractive.