Keeping up to date on coding and documentation changes, is critical for medical coders, billers, auditors, and compliance personnel. Every year American Medical Association (AMA) creates, revises, and deletes CPT codes on January 1st. Same thing occurs with the ICD-10 codes in October.
For CPT codes, the intention of the coding revisions are to clarify and combine services that are routinely being performed together to such an extent that it is more reasonable to have one code, instead of multiple. New codes are created as new innovations are used for the managing and treatment of patients. Services that have been combined or are outdated are progressively phased out.
For ICD-10 codes, new codes are created to capture the ever shifting conditions of the patients being treated. For example, 40 years ago injury due to mobile phones was nonexistent and now it is being treated and managed daily. There are even treatment centers that are focused on treating addiction to social networks.
Codes you have mastered and use every day can have a different definition, and if you continue to use the old code set you may find your practice out of compliance. As a result of code updates, insurance companies have to then revise medical necessity criteria and coverage information.
Not all companies provide education for their staff on coding updates, so it is up to the medical coders, billers, auditors, compliance, and anyone else that performs billing and coding in a medical practice, to keep themselves up to date if the practice is not providing it. For those working in one specialty, it does not take much time to learn about the changes that will affect you directly.
For those working across multiple specialties, it may take more time and there are now many services available to help in closing information gaps. There are conferences, webinars, live training, resources and of course, in the coding books, there are sections that outline the changes and provide some explanation for those changes.
Fee Sheets and any reference tools that are used daily need to be corrected and updated, as well. Although, some carriers allow a crossover period before they start denying charges, that does not mean that the money paid will be kept or that they will not decide to do a targeted review at a later time. It is the best practice to ensure that you minimize the amount of corrections that are required later by staying ahead of the curve and implementing the code changes at the start of the update period (CPT is January, ICD-10 is October). There are even some mid-year updates that will be rolled out, which can still affect you.
It is easy to be lulled into routine by doing the same services over and over; however, it is critical that if you chose to be part of the healthcare industry, you understand the shifting landscape requires constant vigilance. It is what makes healthcare one of the best, and most rewarding industries.
This Week's Audit Tip Written By:
Omega Renne, CPC, CPCO, CPMA, CEMC, CIMC
Omega is a Compliance Consultant with our parent organization, DoctorsManagement.
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