Practice Management Alert

Question: I have a payer that says it doesn't recognize certain CPT codes. What should I do?

California Subscriber

Answer: Although setting up special codes for some insurers may be time-consuming, if you want to get paid on time you have no other choice. Medicare, for example, has special G codes for screening-related tests.

First, check all your payer contracts for any special codes. Next, talk with a decision-maker in the carrier's reimbursement department to find out if they use any other special codes or don't recognize particular CPT or HCPCS codes. Ask for a written list of any alternative codes or special procedure you must follow to get paid.

Also ask the representative how frequently these codes are updated. Make note of how the carrier will notify you about changes and how much lead time they'll give you to prepare for the change. Keep a record of whom you talked with, when, and what was said.

Finally, cross-reference this information in your computer system and billing manual so future bills for that payer will be properly coded and correlated to your fee schedule. Make sure you have a system in place to handle updates.