Are Clunky Medical Billing Codes Costing Physician’s Money?

Are Clunky Medical Billing Codes Costing Physician’s Money?

If you work in the healthcare world you know how confusing billing is. As if learning medicine and practicing on patients isn’t hard enough, a confusing web of interconnected codes needs to be learned to properly bill the patients. In fact, the system seems to be getting more and more complex. The recent introduction of ICD-10 added some 50, 000 codes, increasing the complexity of disease codes by 70%. But could the codes actually be costing physician’s money? A new study is arguing that the CPT codes (short for Current Procedural Terminology) are incapable of coding a significant proportion of family practitioners workload. This means doctors are unable to be paid for work they do every single day.


Medical Billing Codes Costing Physician's MoneyThe Medical Billing Process

For patients to be billed in the correct manner they have to be codified and every procedure and diagnosis needs to be noted. For this to occur providers use CPTs and the ICD-10. They work as follows:


  • CPTs (short for Current Procedural Terminology) codes show what happened to that patient under the care of a given provider. Aka what procedures did they have?
  • ICD-10 is the second part of the codification. ICD-10 provides diagnostic codes for different diagnoses. A patient must have an ICD-10 code to prove that they needed the procedures documented in their CPT.


Are there problems with CPT codes?


A recent study published by researchers at the University of Texas found that around 60% of issues that arose in Primary Care settings weren’t codeable using CPTs. This doesn’t mean that 60% of encounters were uncodeable, just that the Doctors took actions within the consultation that was not directly codeable and therefore not billable. This was a large study of 982 patient-doctor encounters with over 509 different issues addressed. This is an issue in a system that is relying more and more on Primary care. If Family doctors are being expected to take on the management of more complex chronic patients, but are not able to bill for them, then they run the risk of not being paid for a significant proportion of their work.


The study concluded that the CPT codes should either be heavily updated to reflect family practitioners day to day activities or the code should be scrapped completely.


If that all sounds confusing – that’s because it is. Evidently, the current system of coding needs significant work, but for family practitioners working now a more pragmatic solution is needed. The incredible complexity can give many doctors a headache and if you do not understand the minutiae of the system, it can result in a significant loss in revenue.


Some Doctors have looked to outsource the medical billing process to specialist providers in the wake of the increased complexity. For some, this seems to be a good solution. These providers are often experts at what they do, working day in day out with the confusing rules meaning they understand the tricks to improve revenue.

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