Not Coding Correctly, You’re Not Getting Paid

If You’re Not Coding Correctly, You’re Not Getting Paid

The coding process is the most complicated element of medical billing. Instead of having one coding system governed by one body, there are two. ICD-9-CM is governed by the Federal government. This is used to do medical billing for diagnoses and inpatient procedures. The other major medical billing coding system is CPT (current procedural terminology). This is governed by the American Medical Association. It is used to code physician office and outpatient services. Differencing maintaining bodies for coding systems makes it difficult for correct medical billing.

If you do not have correct coding in medical billing, claims will not get paid. They will either be completely denied, or pended for lack of information. If this was the case, payment would be severely delayed.

Unfortunately, keeping up with the medical billing coding is not so simple. Although changes are only made to the ICD-9 systems one time a year, changes to the CPT coding system can happen four or more times. The rules are constantly changing on how to do medical billing with current procedural terminology codes. This means that medical billing personnel must keep on top of the changes.

Even though the ICD-9 coding system only changes one time a year, soon it will create a lot of turmoil. In 2007 a new medical billing coding system will be released. This will be called ICD-10-CM. This is no simple change. Software systems will need to be changed, and perhaps medical billing personnel will have to be completely retrained.

In order to keep up with the times, hiring an outside medical billing firm to handle billing responsibilities is recommended. If your practice hires this type of firm before 2007, you will no longer have to deal with the hassle of training medical billing staff the new coding system. This will be a lot less headache for you. Medical billing firms are extremely skilled at adapting to new systems and procedures.

View all Articles by: Melissa Clark, CCS-P