CPT and ICD-9, now ICD-10 codes are updated yearly. This means that each year codes are added, changed and deleted. When codes are deleted, but are used continuously on claim forms, they will be denied by the insurance company, or the claim will go into adjudication and payment can be delayed for up to 120 days. When a claim goes into adjudication, it essentially goes to a department where an experienced claims representative, will review your claim to figure out why it is being deemed "a problem claim". The insurance company that receives the claim will determine through its in house policies, if they will change your out of date code to the correct code, or if they will flat out deny the claim. But, any of these things happening are bad, because it will either deny you money you have rightfully earned, or you will be reimbursed months later.
A great way to make sure, that you are not still using out of date codes are to have a consulting or medical billing firm come in and review your superbill. If your practice does not have a superbill, then you should list all of the procedure and diagnosis codes that your office uses regularly. Another way to thoroughly vet each code, is to call each insurance company and ask whether the codes on your superbill are still being accepted by that insurance company. Many representatives will tell you the correct, or more up to date code they accept on their claim forms. However, the latter option can be very, very time consuming. The former option is quicker, but you will need to outsource that task, in order to receive the most accurate, and expert advice.
Healthcare Providers, should also be aware that sometimes insurance companies will prefer you to use a different code, than one that is already widely accepted by insurance companies. For instance, United Healthcare does not accept the widely used physical therapy code 97014. Instead UHC prefers a G code. If you put 97014 on the claim, UHC will pay it, but the claim will go into adjudication, and reimbursement can be delayed for up to 90 days. When you receive the EOB, back from UHC, you will notice that they will change the 97014 to G0283. However, if you put G0283 on the original claim, you will receive prompt payment. If you are billing electronically, you will be reimbursed within weeks of UHC receiving your claim.
If you are unsure if your practice is using out of date codes on claim forms, give us a call, we would love to help you. When you contact us about our Physician Billing Services, we will offer to review your codes for Free. We will also review your A/R and perform a cost analysis all for free, so that we can begin to identify any claims that may have denied because of out-of-date codes. Accurate billing is timely billing, and here at Montebello Medical Billing and Consulting, we make sure that our Physician Billing Services, represents both.