CASE RECORDING AND DOCUMENTATION - BILLING CODES
When we enter the professional world, we also enter the sometimes ambiguous world of billing codes. Using correct billing codes is how we get the reimbursement for our services. These codes are necessary in the world of third-party payers. The codes are for specific procedures, diagnoses and certain devices and equipment. ICD-10 codes (and its precursor ICD-9) are the diagnostic codes that must be used for the medical diagnoses which is the base for evaluation and treatment services. ICD is the acronym for International Classification of Diseases. Additionally, we must use the Current Procedural Terminology (CPT) codes that are used to define the nature of our services.
Lists of the various codes are available commercially and CPT codes can be obtained in the Medicare Fee Schedule. Some of us complete our own billing to third party payers such as Medicare, Medicaid, and insurance companies. Others are responsible for the appropriate coding, but actual billing is done by medical billers or billing companies.
As a CRC, you will often be able to get the ICD-10 codes from medical records or physician’s offices. With regard to CPT codes, we need to be aware that there are certain codes such as ones for developmental disorder and autism spectrum disorder that are red flags for insurance companies and are frequently denied by those companies. Also, all insurance companies are different and, although one may reimburse certain codes, another may not. Therefore, one of the skills we will need to develop will be the art of using codes.
Some CPT codes are timed in 15-minute units while others are untimed, although there is usually an average amount of time that a service is expected to take such as 2 1/2 hours for a speech/language evaluation. Documentation is also important. There may be third party payer specific forms to use for services, progress, and discharges. Navigating the reimbursement world will be another challenge for us during our careers.