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Ensure You've Covered CPT And HCPCS Basics

Published on Sat Oct 30, 2004

Handy tool helps keep charge ticket updated and the auditor at bay

There's no question that a well-designed charge ticket keeps any practice on top of its game, but if you don't have all of the elements covered, your practice won't reach "super" status.

As a new generation of codes affects practices in 2005, let our experts walk you through a few design and content tips that will ease the growing pains of your coding process and decrease the easy-to-avoid denials your practice may face:

Use the most current ICD-9, CPT and HCPCS codes:

  • Update CPT and HCPCS annually, AT LEAST

  • Update CPT during the fall when the bulk of the new codes come out.

  • Update ICD-9 twice per year: April and October

    List the complete range of E/M codes:

  • Try placing your E/M codes in three different categories.

  • Identify estimated face-to-face time for each code in case the physician reports counseling/coordination of care time:

    - New patient (99201-99205)

    - Established patient (99211-99215)

    - Outpatient consults (99241-99245)

    Make sure you don't miss any other important code categories such as:

  • Office procedures (e.g., oximetry walking, spirometry)

  • Laboratory (e.g., sputum culture, hypersens. pneumo. profile)

  • Allergy/skin testing (e.g., one injection [allergy], intradermal)

  • Injections (e.g., pneumovax, therapeutic)

  • Drug codes (for allowable injectibles)

  • Panel (e.g., thyroid, lipid profile)

  • X-ray (e.g., chest [single], chest [PA/lateral])

  • Miscellaneous (e.g., sleep diary, smoking cessation consult, insurance forms [extensive or limited])

    Include any scheduled procedures with documentation of:

  • when the patient should return

  • function studies

  • pulmonary rehab/consults

  • stress test information

  • echocardiograms

  • polysomnogram

  • ultrasound

    Next time: Whom is the appointment with, what does the patient need in the next appointment, and when is the next appointment?

    Don't miss: DIAGNOSIS(ES) - and they have to match the procedure

    Extra essentials:

  • Insurance information (policy ID, relationship to insured, prior balance, today's charge, adjustments, today's payments, and BALANCE DUE)

  • Patient demographics (i.e., name, doctor, responsible party)

  • Never forget the physician's signature for any additional notes or comments and the patient's signature for insurance benefit authorization.

    On the flipside:

  • Keep an alphabetized list of all the ICD-9 codes your practice commonly uses on the back of your charge ticket.

    Editor's note: Information in this instrument was  provided by Theresa M. Scott, CPC, account receivables manager with Cabarrus Lung Associates in Concord, N.C.

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