Many urgent care facility coders understand the guidelines around the CPT codes upon which their payments are based. Getting paid depends on knowing CPT. But many undervalue the importance of the diagnostic codes found in ICD-9-CM, which must also be reported on claims.
Diagnostic codes are not tied directly to payment; however, their indirect link can be very costly. Payors look at diagnostic codes for a validation that the service provided was medically necessary. The wrong diagnostic code can result in payment denial for lack of medical necessity, or for lack of specificity. And forgetting to follow the very complex guidelines and coding rules of ICD-9-CM can lead to denials based solely on not following directions. Each payor will have its own rules regarding medical necessity and ICD-9-CM coding. Make sure your office staff has access to that information, as it is vital to prompt and complete payments.
Sheri Poe Bernard, CPC, CPC-H, CPC-P, is vice president of member relations at the American Academy of Professional Coders (AAPC), the nation’s largest education and credentialing association for medical coders. AAPC provides certified credentials to medical coders in physician offices, hospitals and outpatient centers. The three certifications AAPC offers are CPC, CPC-H and CPC-P and represent the gold standard certification for medical coding.
Sheri Poe Bernard, CPC, CPC-H, CPC-P, is vice president of member relations at the American Academy of Professional Coders (AAPC), the nation’s largest education and credentialing association for medical coders. AAPC provides certified credentials to medical coders in physician offices, hospitals and outpatient centers. The three certifications AAPC offers are CPC, CPC-H and CPC-P and represent the gold standard certification for medical coding.
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