Practice Management Alert

Question: Some of my HMO payers have told me to use their codes for certain procedures and not the code stated in the CPT manual. Can they require that?

Florida Subscriber
Answer: Check your HMO payer contracts. If they state this, you must comply with the requirements. In some cases, the request is made from a new employee at the HMO who may be unaware of previous procedures. Establishing a good relationship with the HMO employee can help resolve any differences. He or she may realize the expectations are unwarranted and permit you to use the CPT code.
You Be The Expert and Reader Questions answered by Catherine A. Brink, CMM, CPC, president of Healthcare Resource Management Inc. in Spring Lake, N.J.; Tricia Bardon, BBA, president of Medical Perspectives in East Grand Rapids, Mich; and Barbara J. Cobuzzi, MBA, CPC, CPC-H, CHBME, president of Cash Flow Solutions Inc., a billing and collections consulting company in Lakewood, N.J.