Consistency matters for medical billing codes

Medical billing codes can be more accurate if they reflect the individual needs and stance of providers.

Medical billing professionals need to be consistent and clear with their coding choices to ensure they follow proper regulations and don't contradict themselves. In a recent New York Times article, Elisabeth Rosenthal identified a possible lack of standardization on bills, with statements alternating between CPT, HCPCS and ICD-9 codes with some codes seemingly unattached to any real information.

To be fair, the different code systems do have specific areas where they apply. Medical organizations like the American Medical Association and the Centers for Medicare and Medicaid Services intend them to cover services, devices and diagnoses using specified combinations. However, lax coding oversight can lead to ill-informed decisions about these codes and confuse practices as to which ones are relevant.

Rosenthal spoke to professor Mark Hall from Wake Forest University about the lack of standardization among codes and the way legal systems work in relation to this.

"Medical bills and explanation of benefits are undecipherable and incomprehensible even for experts to understand, and the law is very forgiving about that," he said. "We've not seen a lot of pressure to standardize medical billing, but there's certainly a need.

While using ICD-10 codes correctly is only a part of this larger issue, it's a timely one, given the impending October deadline and the current discussion around banning it altogether. To transition to the new code system, healthcare organizations should create a customized strategy that emphasizes the purpose of specific codes to make the larger set less overwhelming. At the same time, code strategies should also be based on any new changes to existing policies.

An expert medical billing consultant will assist practices in a way that reflects their concerns and needs. With their guidance, bills will be consistent and effective.

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