Taking the Mystery Out of Billing and Coding

November 12, 2019


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If you’ve tried to read the CPT coding manual to brush up on your knowledge of billing and coding but find that you’re distracted or dozing off, you’re not alone. Fortunately, the speakers at a Society webinar set for November 20 have done this tedious but important work for you. “Many practitioners don’t read the CPT manual and aren’t familiar with the specific wording of the codes. And many of the codes are somewhat obtuse regarding the description of medical decision-making and complexity,” says Robert Zorowitz, MD, CMD, one of the program’s presenters.

In Billing and Coding: Something Old, Something New, Dr. Zorowitz and Charles Crecelius, MD, PhD, CMD, will provide details about billing and coding for services that have recently been approved by the Centers for Medicare & Medicaid Services (CMS). Participants will learn the peculiarities of the billing changes for these codes. Drs. Zorowitz and Crecelius will discuss the new direction CMS may be heading for evaluation and management (E&M) documentation and billing as delineated in the proposed Physician Fee Schedule (PFS) for 2019. The speakers also will review and explore the finer points of some classic billing and coding questions that continue to challenge many PALTC practitioners.

“It’s not a secret formula,” Dr. Zorowitz observes. However, coding and documentation can be intimidating, and he and Dr. Crecelius will outline principles of CPT coding and provide resources and citations for more information. “Even with our everyday codes there are still some enigmas that perplex people, and we hope to clear some of these questions up, such as issues related to billing for hospice,” says Dr. Crecelius.

Documentation can be particularly challenging. Dr. Zorowitz notes, “You need to document what you did and what you were thinking at the time. You need to add a fair amount of detail so that anyone reading it knows what diagnostic tests and other information you looked at, who you talked to, and what went into your medical decision-making. You need to make sure the medical necessity of the visit is justified by the documentation.” He adds, “If you do this well, it will not only drive billing, but it’s also useful to let other practitioners know what you did in each patient encounter.”

Dr. Zorowitz stresses the importance of being familiar with the verbiage in the codes. “When documenting, make sure that medical necessity is clear from your notes. Document accurately and thoroughly.” Consider having one or two more experienced practitioners review your billing and ensure that your documentation supports your codes, he suggests.

The webinar has something for everyone, so even coding veterans will gain some new insights. As Dr. Zorowitz says, “Every year a new manual comes out, and there can be significant revisions. The codes change from year to year.” He adds that knowing the codes isn’t enough; practitioners also need to know CMS rules and payor policies. Dr. Crecelius adds, “It’s always good to brush up on the codes. There are many subtle changes over time, and it’s important to be aware of those.”

Elsewhere, while advance care planning codes have been around for a few years, Dr. Zorowitz says, “We still get questions about these, so we will go over them as part of the webinar.” Additionally, Dr. Crecelius says, “We’ll be touching on what’s happening on office codes next year, and what you need to know about these changes.”

 After the program, Dr. Zorowitz says, participants will have a “20,000-foot view of codes and how to use them.” They may not know everything, but they will have a good foundation and know what resources might be more useful for them moving forward. As challenging as it may be, he urges all practitioners to “really dive into the manual. That’s how I did it over the years, and it really makes a difference.”

As always, this webinar is free to Society members. Click here for more information or to register.