The best way to maximize payment from insurers for the services your practice provides to patients is to keep your knowledge current regarding American Medical Association Current Procedural Terminology coding so that you correctly report your services to the payers the first time you submit a claim.
Changes to CPT codes resulting from the AMA/Specialty Society Relative Value Scale Update Committee review and from suggestions by specialty societies are one part of an overall initiative to reform healthcare in the United States. The 2010 Patient Protection and Affordable Care Act has resulted in numerous initiatives to help you offer cost-effective, high-quality medical care to your patients. Accountable care organizations and the medical home model are among these initiatives. Such efforts aim to shift payment incentives from the volume of services provided to the performance and outcomes related to services provided. Accurate CPT coding will be an integral part of this process.
Among the coding-related trends and changes facing you and your fellow physicians this year:
Re-sequencing of codes continues. The requirement for additional definitions and more space within CPT definitions created the need to re-sequence codes, which many times resulted in codes appearing out of order within the code hierarchy. A new symbol (#) was created in CPT 2010 to help you recognize the out-of-sequence codes. This symbol continues to be used in 2011.
Greater transparency in the CPT process also continues. Greater challenges by many stakeholders in the CPT process make creating a viable coding system a significant challenge. Clinical medicine is increasing in complexity and use of technology, the scope of uses for the codes is expanding, the healthcare environment and payment models are changing, and potential conflicts of interest are facing increased scrutiny. All of these challenges add to the dilemma of creating a procedure ID system versus a reimbursement system and requires input from many points of view.
Category II codes. In Category II, 31 codes and four clinical conditions have been added in 2011, and six clinical conditions have been revised.
Category III codes. In Category III, 52 codes have been added and 12 codes have been deleted in 2011. The majority of the deleted codes have been converted to Category I codes.
Please see the chart on page 36 for details about coding changes for 2011, and consult the CPT manual for additional information. Please see the checklist on page 38 for a list of tasks your practice can complete to help ensure enactment of proper coding procedures, financial analysis, and regulatory compliance.
The author is president of Healthcare Consulting Associates of NW Ohio Inc., Waterville, and a Medical Economics editorial consultant. She is a practice management consultant and is certified in coding, compliance, and medical assisting. Send your feedback to firstname.lastname@example.org