BUNDLED CODES:

In an effort to simplify medical billing (and cut their costs), payers have bundled the expected items for certain procedures into one code. This can make billing simpler, if the bundle code exactly matches what was done; but there are often additional steps taken or substitutions required, which must be coded in order to be compensated. However, the coding must then also indicate why it was necessary, in order to avoid the appearance of duplicate charging. It isn’t allowable to simply bill separately for items in a bundle because that may create an over billing situation, which falls under “fraud,” legally.

Multiple doctors involved in the diagnosis and treatment process

The details of what kind of doctor and what kind of medical facility must be specified in the coding for a claim, but it must also specify what level of diagnosis was done, whether there has been a previous diagnosis, etc. By the time a patient is seen by a hepatologist, there is likely to be a trail of examinations beginning with the family doctor. Each of these must be correctly coded, or the payer is likely to deny the claim as duplication.

Highly specialized diagnoses and treatments

There are some conditions that are common within the field of hepatology, but even these have many details that must be included in the coding, and they will not be familiar to medical billers who are inexperienced. It is also rare for a patient being treated not to have related symptoms in other organs or body systems, and medical coding must indicate when this occurs. Having billers and coders who are specialized in the field makes the difference between full compensation and lost revenue due to overlooked details.