CODING: Is Your Practice Losing $160 Every Time You Bill 55876?

Why This Topic Matters

The article matters because it highlights a common source of denials and revenue loss when practices bill for a procedure and its associated supplies. It also helps readers understand why payer responses may differ and why documentation and appeals can be important in resolving claims.

Article Sections

1. Best bet: Be prepared to submit invoices and CPT book photocopies

   Introduces the billing dispute and the kinds of supporting documentation discussed in the article.

2. Myth / Reality

   Summarizes the general confusion about separate reporting and payer reimbursement for associated supplies.

3. Nightmares

   Describes claim denials and the documentation practices used in attempts to obtain payment.

4. Appeal

   Covers the appeal process and the role of invoices and claim-specific review.

5. Positive sign

   Notes a payer policy example and a related unlisted supply approach discussed in the article.

6. Hospitals and professional society response

   Touches on hospital billing considerations and the positions of professional organizations.

7. Controversy

   Reviews disagreement between stakeholders about payment treatment in the Medicare fee schedule context.

8. Bottom line

   Provides the article’s closing summary of the billing and documentation issues raised.