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Pediatric Coding Alert

READER QUESTIONS:

Keep Coding When $$$ Don't Roll In

Published on Sat Jan 27, 2007

Question: When an insurance carrier does not pay for a code, should we still report it?


Virginia Subscriber
Answer: Yes. You should still code for what the pediatrician does. Proper records can help you in many arenas. CPT codes establish an information flow for the services pediatricians provide. Many carriers keep annual CPT code frequency data, and they often base payment on a procedure or service's frequency.

If you do not use a code because insurers do not pay for it, you will be unable to prove the need for that code's payment. Further, you can use this data in contract negotiations to show insurers the value of that code and of your services. You can also substantiate financial loss due to nonpayment of that procedure or service.
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