Q&A WITH NOKOMIS HEALTH DIRECTOR OF CODING ANNE KARL
What are CPT Codes?
As you may know, every procedure code on a claim is tied into a dollar amount. So if a coder miscodes something, the provider could be paid for a code that isn’t supported by the documentation or the clinic may be losing reimbursement that is rightly due to them. Miscoding is typically a result of coders lacking education and not knowing how to code properly or they may be trying to game the system. That’s why insurance companies need a claim review partner. We can look for trends that we see in the claims and set an edit to manually review those claims or automatically deny them. Just because there is a CPT code doesn’t mean that you can use that code for reimbursement or use it for reimbursement in combination with other codes.