Medical Coding and BillingAs the New Year approaches, anticipated changes in medical billing and coding will bring unique challenges for healthcare providers and their medical billing staffs. In order to get proper reimbursements for services provided, physicians will have to be well prepared for these changes.

Most Anticipated Changes

According to experts, the following are some of the major coding and billing changes expected:

  • ICD-10 Transition – With more than 141,000 diagnosis codes, the transition to ICD-10 will be a significant challenge for healthcare providers. Errors in implementing systems, coders’ learning curve, payers’ internal systems not working as expected, and other such issues will impact practice reimbursements.
  • CPT Code Changes – Additional changes will be there in vascular and non- vascular interventional radiology as well as in breast imaging and radiation therapy. There will be significant changes to coding for lower GI endoscopic procedures in CPT 2015. Upper GI endoscopy changes were implemented last year. These changes follow similar revisions to the upper GI endoscopy codes in CPT 2014. Changes will be evident in the terminology relating to placement of stent, control of bleeding, ablation, endoscopic mucosal resection, enteroscopy, ileoscopy, pouch endoscopy, flexible sigmoidoscopy, and colonoscopy through stoma. There will be neew codes for the colonoscopy family.
  • Changes for Modifier-59 – CMS introduced four new HCPCS modifiers with distinctive descriptors such as
    • XE Separate Encounter
    • XS Separate Structure
    • XP Separate Practitioner
    • XU Unusual Non-Overlapping Service

    CMS will continue to recognize the -59 modifier, but when a more descriptive modifier is available the -59 modifier should not be used. Physicians must understand and use the four new modifiers to describe services.

  • Code Bundling – When a procedure or a service with a unique CPT or HCPCS code is included as part of a more extensive procedure or service then it is called bundling, i.e., combining two or more CPT codes into a single code. This will lead to lesser reimbursement for a number of procedures. Radiology is also affected by bundled codes. For example, breast biopsy procedures are now bundled with the guidance codes and only one CPT code will be enough to code for any breast biopsy procedure with guidance code.
  • Maximum Non-Network Reimbursement Plans (MNRPs) will Rise – It is expected that payers will offer more MNRPs or Medicare-based plans due to their lower rates of reimbursement by 2015.
  • Increased Demand for Specificity – With the upgrade to ICD-10, payers will demand claims to be coded with the highest degree of specificity. Many are also requiring that complete medical records accompany claim submission. In order to avoid claim denials, physicians will have to write more information in the medical record to support the new codes, and coders will have to code claims in more detail.

Proper revenue cycle management with error-free medical billing and coding is necessary for improved patient care, on-time reimbursement and improved efficiency. So partnering with a medical outsourcing company is an ideal option to deal with these upcoming changes and challenges.