Medical Coding – Stick to the Rules

by | Last updated Jun 14, 2023 | Published on Jun 10, 2013 | Medical Coding

Medical Coding
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Error-free medical coding is necessary for to prevent denials and ensure timely and proper reimbursement. To get your codes right, rely on the coding guidelines that can be found in the CPT code book and payer policies. All healthcare providers and insurers usually go by HIPAA rules and use these medical codes. However, insurers could sometimes change payment policies and coding requirements. For instance, depending on the number of units, bilateral procedures can be reported in different ways.

The CPT code book contains coding guidelines on the sections and subsections of various procedures. They may include a description of the main procedure and additional procedures performed. This comes in useful when submitting bills for payment, but you have to apply the right rules to ensure proper reimbursement.

For instance, the coding guidelines for malignant excisions codes 11601-11646 say that a simple closure is included in the procedure. If the excision site needs an intermediate or complex closure, the closure can also be reported if conducted. If you overlook this guideline and do not code the complex or intermediate closure, you will lose reimbursement.

You also have to know the difference between the payment rules for Medicare and private insurance companies. Many practices make the common mistake of applying Medicare rules to all insurers. This can cause improper reimbursement or even denials. Make sure you have all the necessary information on Medicare payment rules as well as those of private insurers, which are available in payment policies, provider-payer contract and provider manuals. The CMS website for Medicare coding requirements contains information about National Coverage Determinations (NCDs), Medicare Claims Processing Manual and Local Coverage Determinations (LCDs).

The best way to ensure HIPAA complaint medical coding is to rely on professional support. With AAPC certified medical coders on board who are up-to-date on changing rules and policies, an established medical coding company can provide quality medical coding services in time to suit your requirements.

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    Natalie joined MOS’ Revenue Cycle Management Division in October 2011. She brings twenty five years of hands on management experience to the company.

  • Meghann Drella
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    Meghann joined MOS’ Revenue Cycle Management Division in February of 2013. She is CPC certified with the American Academy of Professional Coders (AAPC).

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  • Loralee Kapp
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    Loralee joined MOS’ Revenue Cycle Management Division in October 2021. She has over five years of experience in medical coding and Health Information Management practices.