Maximizing Reimbursement with Accurate ICD-10 and CPT Code Selection

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Accurate coding and billing is a key component in your medical practice receiving maximum reimbursements. One small error can cause a claim denial and lengthen the time to receipt of payment. While it may seem like a straightforward proposition, the world of ICD-10 (International Classification of Disease 10th edition) and Current Procedural Terminology (CPT) codes is complex and changes frequently. In fact, payors reject more than 30 percent of submitted claims. 

These coding and billing errors can significantly impact your cash flow and strain resources. If this is a significant issue for your organization, you have options for streamlining the process and eliminating most errors. 

ICD-10 and CPT Codes: Most Common Issues

ICD-10 and CPT codes are both critical in billing. ICD-10 defines the diagnosis or condition, while CPTs describe symptoms and record treatment. Here are the most common errors for each.

ICD-10 Errors

CPT Errors

All of these mistakes can lead to a quick denial and big reimbursement headaches. So, what can a modern medical practice do to reduce errors and code more accurately? 

Best Practices for Greater Accuracy and Faster Reimbursements

There are many ways to be more efficient and effective at coding. You may already have coding policies and workflows, but these additional priorities will still help your organization improve accuracy.

Stay Updated on the Latest Coding Changes

ICD-10 codes are still in use, with the 11th version published in 2022 but not fully implemented. Thus, you’ll need to stay in the know about the transition. Each year, updates related to ICD and CPT codes include additions, deletions, and revisions. These complexities may create a daunting task for you and your coders, but not nearly so daunting as trying to play catch-up.

Develop Efficient Workflows 

As with any aspect of practice management, you’ll need to streamline the process. If you have a defined process supported by technology and people, you can eliminate many errors and speed up reimbursement by implementing automation components Even so, you’ll still need billing experts to engaget and monitor software coding recommendations. 

Complete Final Reviews Before Submission

Even with automation in the billing cycle, every claim needs a final review. The software you use may catch most errors, but a manual review of the most complex claims is another safeguard to ensure accuracy. 

Audit the Process

It’s good practice to audit your coding workflows regularly using insights from your own data about denials and the most frequent errors. The audit should focus on the systems and processes you use and existing gaps. 

Use the Right Software

There are lots of software options that assist with coding and billing. What you select depends on your specialty, size, needs, and whether you outsource or keep the work in-house. Whether you’re looking to upgrade or purchase your first platform, evaluate multiple platforms to find the one that fits your workflows, requirements, and budget.

Achieve Faster Reimbursements: Solutions for Outsourcing and In-House Billing

The best practices presented above coalesce around two key themes: people and technology. You’ll need both to accelerate the cycle and improve accuracy. The good news is that you have options  when it comes to both outsourcing and in-house billing.

With outsourced Revenue Cycle Management (RCM) services, your practice can tap expert billers who are AHIMA-credentialed. These coders use RCM software that usually identifies correct ICD-10 codes and errors. Highly experienced professionals simply add another layer of verification and validation. 

Staying in house, you can use Practice Management software with a claims center module. This tool helps your billers choose the proper ICD-10 codes. The software is smart enough to guide your staff, but they’ll still need to stay updated on coding changes. 

ChartLogic can support either avenue to improve reimbursements. Learn more about our RCM solution and Practice Management platform today.