Code accurately for best reimbursements

Published: 2009-11-01 22:04:28
Author: Mark Sanna | Chiropractic Economics | May 2008

ORLANDO, Fla. — If you don’t have it documented, it doesn’t exist, Mark Sanna, DC, told a standing-room only audience at a Chiropractic Economics’ Boot Camp session of the Florida Chiropractic Association (FCA) conference. Sanna was referring to insurance reimbursements. “And every request for reimbursement must be based on medical necessity.”

“The OIG (Office of Inspector General) and HIPAA monitor reimbursements closely today,” said Sanna. The way to stay out of trouble is to code procedures to describe the work you have done accurately — not to try to get maximum reimbursement. “If you assign a code because it bumps you up in reimbursements, you will place your whole practice at risk from a compliance perspective,” he cautioned.

Sanna, CEO of Breakthrough Coaching, conducted a workshop on “Reimbursement Coding and Insurance Strategies That Work.” He reminded the audience that coding is merely talking to a computer. “It’s a matter of giving the right number to the computer to get paid.”

Because the coding system was designed for the medical doctor, think about using it is a game, Sanna said. “It requires you to stay a few moves ahead.” Sanna’s presentation focused on ways to improve reimbursements, which he said should be used conservatively. Some are often overlooked:

• Consultations with a physician referral — 9924(2-4). Use this code when you have a direct referral from a physician, as long as you send a report to the referring physician to communicate your findings and care plan.

• Patient-initiated consultations — 9927(2-4). These codes are used any time a patient initiates a confirmatory consultation and you generate a report that is sent to the previous physician. “When you send these reports out,” said Sanna, “it builds your practice.” But, he cautioned, never send a report to the medical doctor without the patient’s permission. And remember to revert to “established patient” codes when you assume responsibility for the patient’s care.

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