Practices need to implement new code set by January 1
In past years, we've all hibernated through the winter, not worrying much about the latest CPT codes. Everyone knew the payers weren't really expecting to see them until spring. This gave us time to update our superbills, add codes to the fee schedules, check and compare coding techniques, and generally get ready in a somewhat leisurely way.
Well, that's all about to change. Consider it another side effect of HIPAA.
There will be no grace period in 2005 -- at least from Medicare -- for coding changes. All practices needed to start using the new, changed, or deleted codes on January 1. And the 2005 ICD-9 already went into effect back on October 1, 2004.
Welcome to the new year.
It is not entirely clear if the commercial payers will follow Medicare's lead. Surely, many will not be ready and won't be able to process the new 2005 codes. That means you may need to code one way (the old way) for some payers and a different way (the new way) for Medicare. But over the first quarter of 2005, payers will switch to the new codes, and you need to be ready.
A sudden shift by commercial payers will certainly cause old codes to be denied as invalid. Watch your EOBs very carefully. Often they will come back with a cryptic message like "Unable to process claim due to lack of information" or "Invalid or incomplete coding." Don't count on too many payers to clearly state "You used the wrong code, update your system." Look for denied codes; then recode with the correct, new code and resubmit immediately.
And beware of bogus timely-filing denials -- the coder's death sentence. I fear for practices that are not paying attention and will allow denials to "time-out" into timely-filing denials.
Let your teamwork show
As with all changes, I see opportunity. In this case, it's an opportunity to see who is prepared. This is the chance for seasoned, savvy coders to shine, a season when the teamwork between coders, billers, and payment posters will be evident. (It will also be abundantly clear when your practice's reimbursement team is not working together.)
So what is a practice to do?
As you do every year, be sure to order -- and read -- the new CPT and ICD-9 books, if you haven't already. Changes are noted in special colors (check the key of the version you have for the right color or typeface to look for); new codes are indicated in the CPT with a big dot. Be sure you understand what has changed for the codes you use the most and update your billing procedures and paperwork accordingly.
Train your staff so that all Medicare claims are sent using the new code set. Do your best to get information from your main payers about when they expect to shift their requirements.
There is no rest for the weary this winter. But at least by spring things should be easier than usual.
This article originally appeared in the January 2005 issue of Physicians Practice.