What is the most common billing mistake?
Incorrect coding or insufficient documentation is the most frequent cause of delayed or denied payment.
How can documentation prevent denials?
Clear operative notes, diagnosis linkage, and detailed medical necessity narratives significantly reduce denial risk.
What is a medical necessity narrative?
It is a detailed explanation written by the surgeon explaining why the procedure is required for functional or reconstructive reasons.
How are assistant surgeons paid?
Assistant surgeons are typically reimbursed at a reduced percentage of the primary surgeon’s allowed amount.
What are CPT codes?
CPT codes are procedure codes used by providers to describe what surgery was performed. Insurance payment is based on these codes.
Why do CPT codes matter?
If a procedure is coded incorrectly, the claim may be underpaid or denied, even if the surgery was appropriate.
What are ICD-10 codes?
ICD-10 codes are diagnosis codes that explain why a procedure was medically necessary.
Why does documentation matter?
Insurance companies require documentation linking the diagnosis to the procedure to justify payment.
What is bundling?
Bundling occurs when an insurer combines multiple services into one payment rather than paying for each individually.
What are modifiers?
Modifiers are two-digit codes added to CPT codes that provide additional details about the procedure performed.