Physician coding for billing, insurance claims and accurate medical records is a fast-growing healthcare market sector. It is important that the information related to the specific coding practices at a physician’s practice is circulated among all the staff members requiring them to follow the guidelines. Physician coding guidelines can help an organization in time of an audit or an investigation, or just for everyday accuracy.
There are basic coding guidelines for inpatient encounters and for outpatient encounters released by the Federal Government. In addition, CPT (Current Procedural Terminology) coding, which is officially recognized, comes from CPT Assistant, published by the American Medical Association.
CPT physician coding provides a list that mentions the descriptive terms and the identifying codes used by physicians and other medical professionals for reporting medical services and procedures. CPT provides a standardized language for all medical practitioners for describing medical, surgical and diagnostic services. This coding method gives the physicians a standard means of communication, even when they are communicating with third parties or even within practices, clinics or hospitals.
CPT codes must also be present in HCFA-1500 claims for physician services and UB-92 claims for hospital outpatient systems. Physicians generally use CPT codes 0063T, 0062T and 64999. These coding methods make the billing and reimbursements for physicians and medical practitioners easier.
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CPT is a documentary statement that contains the billing codes of the treatment that is given to the patients. This code is unique and given for each patient. It is also useful in case of health claims, as it provides the details of medical treatment provided to a patient. Professional coders and accountants do this coding. These coders have to follow the rules and regulations laid down by AMA.
These coders and accountants are hired from private companies who provide medical practitioners with quality service by providing a record of bills and treatment of specific patients.
Physician Coding and HIM
The physician coding guidelines are developed and maintained by HIM managers. The coding guidelines evolve with the help of people including the coding staff, the medical staff, the compliance officer, the clinical committees and the HIM committee. The coding staff needs the full access to information regarding the rules to apply.
The medical staff assists an HIM manager in clarifying documentation. These people also act as an aid in ensuring that all procedures are in accordance with treatment protocols. The compliance officer is required for approval of the guidelines, but he/she is not necessarily a coder. The clinical committees can vary in number and type according to the need of the specified healthcare organization. The HIM committee, an organized and recognized committee, gives the final approval of the guidelines.