Why is procedural coding important

For additional information about codes used to bill Medicare for specific types of care, please see the Medicare Claims Processing Manual. The manual lists which codes are used to bill each care type of interest.

Consulting with a medical coder at your organization may be helpful as well as searching the literature through a website such as PubMed for examples of codes that others have used when studying a particular topic. Diagnosis and Procedure Coding Resources. Purpose Providers that bill Medicare use codes for patient diagnoses and codes for care, equipment, and medications provided.

This articles provides resources to identify the codes used in Medicare claims files. Current Version Date:. Additional Resources. Article Information Author:. Data Files or Variables. The process and materials mentioned as part of this KnowledgeBase article are current, as of the publication date on the article, to the best of our knowledge.

Complaining, questioning or asking for review is now my default action whenever I get anything from my insurance company. Over the past 2 years, this action has saved me literally multiple thousands of dollars. I even had a billing specialist at my doctor tell me that this is their strategy. The more you complain, the more it magically gets lowered.

And they try to wear you down by giving you a hard time. I agree, there is really no other industry ran like this. Where else do you go in for service, they give you no indication of how much it will cost even when you ask , then send you a bill months later and expect you to pay immediately. Most people cannot budget for that. Also, no other service could get away with that. I have had babies born in 2 of the last 3 years so I have hit the max deductible for those years.

Many public libraries will have a copy of CPT in their reference collection. Probably not the very small libraries, but if you have a main branch or a larger town nearby. One other major component to a medical claim that I want to point out is the diagnosis code. All providers are required to indicate a diagnosis code reason for the services. Many CPT codes can either be diagnostic or routine in nature and the final determination will be made by which diagnosis code is billed in conjuction with it.

However, most insurance companies will not disclose this as it often leads to questions or disputes as to why the services were rendered. They also often struggle to grasp the concept that diagnosis codes and CPT codes are inter-related. Hope this helps you all. Remind them that it is always better to correct their own mistakes… especially before anyone knows they made them. To err is human, and therefore, building the habit of double-checking our own work is key, especially in a field where accuracy is the most important work product.

Those of us who know coding understand how challenging it can be for a beginner venturing into this unknown territory. Safian and Mary A. Skip to main content x Sign In. Share This Article d a E. Action 1. Action 2. Query, if necessary In the classroom, and on the job, asking for clarification or additional information is critical to accuracy.

CODING BITE Review with your students that a legal query must ask open-ended questions or provide multiple choice options to ensure the question does not appear to influence the answer. Action 3. Code the diagnosis or diagnoses Action 4.