Primary Care Coding Alert

Question: When an insurance carrier does not pay for a code, should we still report it?

Virginia Subscriber

Answer: Yes. You should still code for what the FP does. Proper records can help you in many arenas. CPT codes establish an information flow for the services FPs provide. Many carriers keep annual CPT code frequency data, and they often base payment on a procedure or service's frequency. If you do not use a code because insurers do not pay for it, you will be unable to prove the need for that code's payment. Further, you can use this data in contract negotiations to show insurers the value of that code and of your services.