CPT^® CODING MADE EASY

If CPT^® Coding Made Easy Saves You from Just One Error, You've Recovered the Cost of the CD and More!

Helps Coders Prevent Claim Denial, Avoid Potential Losses, and Capture Easily Missed Procedures

Example: Catheter drainage of the liver is often a multi-stage procedure. If a second stage is required in postoperative period after initial catheter insertion, it may be denied unless the -58 modifier (staged procedure) is added to the second-stage procedure.

Potential loss without the modifier: $1534.88 for non-Medicare payer, $306.97 Medicare.

Reduces Audit Risk and Increases Savings

Example: When a balloon catheter is used to remove a clot from an arteriovenous fistula, coders may inappropriately use code 35875 because reimbursement for it is very high. CPT^® Coding Made Easy includes an alert that 35875 is upcoding because it is to be used to report clot removal from a major graft, and alerts coders to use 36831, 36833 or 36870 instead.

Audit risk: Substantial for physicians who frequently bill this procedure! Penalties include refund of three times the overpayment and fines of $10,000 per false claim, among others.

Optimizes Dollars by Helping Coders Legitimately Avoid Payer Rebundling Edits

Example: Separate biopsies of each breast lesion after the first are often denied by third-party payers when they bundle them together and pay only for the first biopsy, unless the correct modifier is reported. Coding notes at 19100 - 19103 alert coders to add the -59 modifier for each individual lesion to avoid bundled payment.

Potential savings: For each biopsy after the first, the savings for 19100 are $207.78 (50% amount) non-Medicare; $41.56 Medicare. Savings for 19101: $387.34 (50% amount) non-Medicare; $77.47 Medicare.

Increases Coding Accuracy with Procedure Descriptions and Notes for Hard-to-Code Procedures

Example: CPT^® Coding Made Easy explains to coders the single key difference between code 93508 (catheter insertion for coronary angiography without left heart catheterization) and other coronary angiography codes with cardiac catheterization.