BC Advantage - 2019 Issue 8
But All My Friends are Doing it
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Article Overview
This article discusses why common billing practices are not automatically correct and how audit education should be supported with authoritative sources. It uses a shoulder arthroscopy example to illustrate how CMS and CPT guidance, NCCI edits, and related modifier use are reviewed in a compliance context. The piece is aimed at auditors, coders, compliance staff, and provider educators who need to assess whether billing patterns align with official guidance.
Why This Topic Matters
It helps readers understand how to support billing and modifier decisions with official references rather than informal habits or peer practice. That matters because incorrect reporting can create audit exposure and compliance risk.
Article Sections
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Compliance mindset and audit awareness
Introduces the theme of questioning common billing habits and emphasizes the role of audit scrutiny and provider education.
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Using authoritative resources for education
Describes the kinds of official coding and coverage resources used to support compliance discussions and billing review.
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Shoulder arthroscopy example and modifier review
Presents an orthopedic surgery scenario and discusses how official guidance is consulted when evaluating bundled services and modifier use.
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CMS NCCI policy guidance
Summarizes the relevant CMS NCCI policy manual material used to review arthroscopic shoulder procedures.
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Conclusion and provider education takeaway
Wraps up the example by reinforcing the importance of relying on authoritative guidance when educating providers.
What You Will Learn
- How compliance articles use official sources to support billing education
- How audit awareness affects provider communication
- How CMS and CPT guidance can be used in a coding review context
- How a shoulder arthroscopy example is evaluated against official policy
- How modifier-related concerns are discussed in audit education
Who Should Read This
- Medical coders
- Compliance auditors
- Billing staff
- Provider educators
- Practice managers
- Compliance consultants
Codes Discussed
Code Ranges Discussed
Modifiers Discussed
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