To code, or not to code?

Abstract

In summary, it is also important to remember the hidden rules: 1) Just because there is a code in the manual, it doesn't mean it can be billed to insurance, or that once billed, it will be reimbursed. 2) Just because a code was paid once, doesn't mean it will ever be paid again--or that you get to keep the money! 3) The healthcare provider is responsible for knowing all the rules, but then it is impossible to know all the rules! And not knowing all the rules can lead to fines, penalties or worse! New codes are added annually (quarterly for OPPS), definitions of existing codes are changed, and it is the responsibility of healthcare providers to keep abreast of all coding updates and changes. In addition, the federal regulations are constantly updated and changed, making compliant billing a moving target. All healthcare entities should focus on complete documentation, the adherence to authoritative coding guidance and the provision of detailed explanations and specialty education to the payor, as necessary.