Coding success key to reimbursement


Proper coding of insurance claims is important to reimbursement. Sean Roddy, MD, Chair of the SVS Health Policy Committee, has long had an interest in this subject and recently presented top coding tips for proper reimbursement at the Northwestern Vascular Symposium in December.

The most important method to ensure correct coding is through documentation completeness, according to Dr. Roddy. While many physicians wait until the end of the day to complete all surgery and angiography documentation, that practice may not yield the best results.

“While certain details might not be important from a clinical standpoint, they are vital to proper coding,” Dr. Roddy said. “In the billing and coding world, if something is not included in the procedure notes, it did not happen and is, therefore, not reimbursable. It is important to take the time to dictate what you really did so you can be paid appropriately.”

Dr. Sean Roddy

During his presentation, Dr. Roddy emphasized the importance of submitting a correct claim initially, since an original claim is much more likely to be paid than an appeal. To help ensure accuracy, Dr. Roddy recommended scrubbing software which can be customized to identify errors prior to claim submission.

“At least 10 percent of our claims have a typographical error,” Dr. Roddy said. “You want to get it right the first time, not spend staff time and money appealing claims. Billing software is available on many practices’ systems, but it is often not activated, updated, or used when it could be. An investment in scrubbing software helps make it right the first time.”

However, do not ignore claim rejections and accept them as a loss. Instead, analyze them to see if a pattern emerges. Also remember to submit claims in a timely manner.

There are also multiple procedures in the CPT manual where two different codes describe the same procedures, so it is important to be familiar with those definitions, Dr. Roddy said in his presentation.

Unfamiliarity with definitions may result in a procedure being under-coded with less reimbursement. Also don’t neglect to use the add-on codes which are used to define more difficult situations and compensate the physician for added complexity and time.

It also helps to pay attention to carrier-specific billing rules. Staff needs to know dates, providers, modifiers — rejections reports sometimes hold the key to this information. Coding staff should also be aware of Medicare’s many rules, including local coverage determinations.

Following his Northwestern presentation, Dr. Roddy and Robert Zwolak, MD, gave the Society’s first-ever Webinar, 2014 CPT Coding Update, which is available on demand through January 31. SVS has additional resources to help its members improve reimbursement through proper coding, including the annual coding workshop and the recently released Coding Guide 2014.

“There are coding changes annually and someone in every vascular surgery practice has to know what’s new each year,” Dr. Roddy said.

“Doctors focus on patient care and may pay less attention to coding. But if you don’t focus on coding, someone in your practice has to do it for you,” he concluded.


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