Medicare Billing Codes and CPT® Coding Guidelines

Healthcare payments in our country have been documented for many years by the use of Medical Billing Codes such as the CPT®. The CPT® is managed by the American Medical Association (AMA), which issues CPT® Coding Guidelines and regularly updates these to reflect changes. These changes are a result of changes in the prevailing wisdom about procedures, changes in the prevailing practice, and the frequent changes in technology. These codes were initially designed to ensure a uniform understanding of patient history when a patient undergoes multiple procedures in multiple locations. However, these codes became more important when they were used for billing purposes, especially for medical insurance payments and repayments. Thus, it became very important for medical facilities to follow CPT® Coding Guidelines to ensure they were paid and reimbursed.

The expansion of Medicare through the Affordable Care Act has only increased the importance of these codes. As more and more Americans begin to fall under the cover of medical insurance, CPT® codes have become the Medicare Billing Codes; and have thus become the fundamental building blocks for recording medical procedures. These codes are used for billing, documentation, reimbursements and payments – meaning that when the CPT® coding guidelines are not followed, medical service providers might not receive their payments. Even small errors will cause delays and a loss in terms of attached costs.

The expansion of Medicare and the switch between ICD-9 and ICD-10 has also meant that this has been a period of great change in healthcare coding. A reason for much confusion in coding, billing and healthcare compliance. These changes have come because of various reasons – changes in the regulatory regime (with Medicare and Medicare Billing Codes), changes in the International Standard (ICD-9 to ICD-10) and interpreting the impact of the change on domestic markets, and changes in technology and prevailing procedure (increase in bundling, change in technology for various imaging and diagnostic tools). It is extremely healthy and useful to have a system that is dynamic and accounts for the rapid changes in the healthcare sector. Having new codes for new technologies encourages all parts of the healthcare payment chain – consumers/patients, doctors and medical service providers, insurance companies – to become aware of the inclusion and use of the new methods and technology.

However, there is no doubt that so many frequent changes definitely lead to difficulties. Those responsible for dealing with coding for doctors and medical service providers often find themselves behind the current codes, and not following the latest CPT® Coding Guidelines or Medicare Billing Guidelines. Ensuring that the staff and doctors and medical service providers are up to date with the current coding standards and practices is essential to ensuring that you do not lose any money. And certainly not to errors in coding, because having reimbursements that get stuck because of errors in coding are incredibly difficult to realize, meaning large compliance costs as well as loss of payment. The penalties for faulty coding are also severe. In such circumstances, regular training and expert guidance can make all the difference. At AudioEducator, you can find the updates, training and information you need to master Medicare Billing Codes and CPT® coding guidelines. For more details on our upcoming events in Medicare coding, billing and CPT® coding guidelines, bookmark our blog.

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