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Pain Management Coding  


Superbills. When you think of them, what jumps to mind? "Fast"? "Efficient"? How-about "Ineffective". "Outdated". "Potentially Not Compliant". Superbills are a true double-edged sword. On the one hand, they are fast, they are concise, and you have probably purchased one which has your most commonly used codes on it. Sounds great, right?

Well, not as great as you would think. Superbills are indeed fast, there is no questioning that. It probably takes you 30 sec. to a min. to code one of your very common cases if you're flying through it. So far, it's about equal time-wise when compared with Pain Management Coding Wizard™, and depending on how well you know your Superbill, might even be a little faster.

However, what happens when you have a case that's not on your superbill? Do you search through a CPT book? How long does it take to find the correct code in the CPT book? 5 minutes? 10 minutes? This is way too long to spend just flipping page by page in desperation through the CPT book. You have other things you need to do.

Once you find the correct CPT and ICD-9 (which you will also have to look up), how do you actually know that they're correct? To expand, what if you have a multiple procedure case you need to code? Once you look up one (or more) of the CPT codes and the ICD-9s, how do you order them correctly? How do you find the Relative Value Units (RVU) and order the codes by descending RVU, so that you get reimbursed at the highest rate for your most expensive case? Can you even bill the codes together? What modifiers do you use?

To further this, a trend in superbills seems to be an inclusion of generic ICD-9 codes, not specific ones. Many times these ICD-9s will technically "get the job done", being generally applicable. However, thorough (to the fifth digit if possible), specific ICD-9s are better not only for documentation purposes, but also to submit for billing, and can sometimes be the difference between reimbursement and case rejection.

These types of obstacles can lead to inaccuracy and superficiality in coding, which in turn can lead to case rejections and a lack of compliance.

Now for the question of the currency of your superbill. When was the last time your superbill was updated? Has it ever been updated? Did you know that your superbill needs to be updated? ICD-9s have amendments, revisions, and additions every year. The CCI edits (which greatly affect compliance, and also the acceptance or rejection of your case) are updated quarterly. There are also amendments, revisions, and additions of CPT codes. These update cannot be overlooked. They not only affect your accuracy, and therefore your case acceptance/reimbursement rate, they also have a substantial impact on the overall compliance of your coding and your practice.



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