Practice Management Alert

Question: We keep getting denials on certain codes from certain payers. My physician says we should just stop billing the codes that our payers never reimburse us for, even when they are the proper codes for the procedures he performs. Is this the case?

Arizona Subscriber

Answer: If there is a CPT code for the procedure your physician performs, you should always bill that procedure code. Even though your payer isn't paying you on a code, that doesn't mean you should stop reporting it.

By reporting a code, you-re not only correctly portraying the services your physician performed, you are also showing the payer that the code is getting used. Eventually, if enough physicians are using a code, a payer may assign a value to it and begin reimbursing you.

Plus: If you stop using a code, and so does the rest of the physician community, CPT may eventually delete the code with the premise that physicians don't use the code.

-- The answers to the Reader Questions and You Be the Billing Expert were provided or reviewed by Barbara J. Cobuzzi, MBA, CPC, CENTC, CPC-H, CPC-P, CPC-I, CHCC, president of CRN Healthcare Solutions, a coding and reimbursement consulting firm in Tinton Falls, N.J., and senior coder and auditor for The Coding Network.