Why Certified Coders?

How do I code for this product? A typical question a medical device manufacturer receives. Be careful with your answer. Inaccurate or haphazard coding advice can be fraught with legal and ethical issues. One inaccurate answer can undo important relationships you’ve spent a lot of time cultivating with your customers. Using independent certified coders is one way to ensure your coding advice is accurate and in compliance with Medicare and commercial payer coding guidelines.

Coding is a nomenclature system used to communicate what was done and why it was done, between providers and third party payers. The following table details the most common medical coding systems used by physicians and facilities.

Coding System Used to Describe Used By Example Description
ICD-10-CM Diagnosis The patient’s primary, secondary, etc. diagnosis(es) that prompted treatment All providers of service M17.31 Unilateral post-traumatic osteoarthritis right knee
ICD-10 PCS What was done Hospital Inpatient 0SRC0(7,K)Z Total knee replacement
CPT Procedure Code
  • Physician’s professional services
  • To determine outpatient APC assignment (Medicare only)
  • ASC Services
  • Physician
  • Hospital Outpatient (for Medicare only)
  • Ambulatory Surgery Centers
27446 Arthroplasty, knee, condyle and plateau; medial OR lateral compartment
Pass-Through Codes A type of HCPCS code used to describe certain ‘new’ devices approved by Medicare & used in the hospital outpatient depts. Some pass-through codes result in additional hospital payment; others are used only to track utilization & cost. Hospital Outpatient (for Medicare only) C1776 Joint Device, Implantable

Coding Rules: There are a myriad of coding rules and regulations detailing when specific procedures can and cannot be used. These coding conventions change regularly too, making it difficult to keep abreast of current coding dos and don’ts.  Manufacturers should rely on medical coders with certification from reliable qualified entities such as the American Health Information Management Association, AHIMA and/or the American Academy of Professional Coders AACP, to assess coding for professional and facility claims.

Take the challenge. Would your sales representatives be able to answer the following question?

Q: If an endovascular atherectomy procedure is performed, can the physician code and bill for the radiological supervision required to perform the procedure?
A: NO, although a few years ago separate coding for the radiological supervision was permitted. Current guidelines bundle the radiological supervision into the atherectomy procedure.

Reimbursement Principles Inc. has certified coders, credentialed with the American Academy of Professional Coders (AAPC) available to assess coding for your physician and facility customers providing you with coding confidence. Please contact us for more information.

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