2014 Hotline Success Case 1: Prevented Billing with Incorrect Codes, Leads to the Assignment of a Specific CPT Code

For a device / biologic billed with an unlisted J code, competitors and coding experts were recommending the incorrect codes. Providers who participated in Coding Blogs and reviewed Coding Newsletters  were  resistant to our client’s Billing Guide and The Global Integrated Reimbursement Services (GIRS)  InContact Reimbursement Line™ guidance to accounts on the appropriate codes.  The use of incorrect codes could have lead to increased risk of audits for providers. The President of GIRS met with the American Medical Association (AMA) staff and requested guidance be published on the codes to educate providers.   We also met with the Coding News Letter Editor and educated them of the appropriate codes. Accounts were constantly educated on the appropriate codes and the AMA guidance was provided to accounts through the InContact Reimbursement Line™. To clarify the coding , the AMA staff themselves drafted a coding application for a specific CPT code for the technology. The GIRS President presented to the CPT Editorial Panel in support of the code and developed specialty society support. A specific code was  assigned and this has reduced the provider confusion.