I hear people say “billing and coding” “coding and billing” like they are one in the same.
Medical coding and Medical billing are two very different things. Different things that work together but very different.
What guidelines do you follow?
So, I have made it a personal rule to always follow Medicare guidelines when it comes to coding and everything should be fine because everyone eventually follows what Medicare says to do.
ICD-10-CM- has a set of guidelines that coders must follow when coding a note
CPT has guidelines that a coder must follow when coding an encounter or procedure
Payers have guidelines that we must follow to bill claims
Contradicting guidelines
Sometimes, when billing, we have to go against what our coding guideline says.
A good example is code sequencing. Sometimes our code books tell us one way to code, but payers want the codes in a different order, and in order to get the claim paid, we must follow the payers’ guidelines.
All payers do not follow the same guidelines
It is best practice to go by what CMS is telling you because if a payers denies or rejects your claim, you have more protection by telling them you followed CMS guidelines!
Most if not all payers also follow CMS guidelines
As a coder/Biller it is your responsibility to look up what each payer requires and if they cover certain codes pr not.