14 I Summer 2018 www.anjc.info [ CONTINUED FROM PREVIOUS PAGE ] If the patient comes in with a condition that warrants the evaluation, then it will likely at least meet the criteria for 99212. For a full review of how to choose the proper levels, Providers should look to either the 1995 or 1997 guidelines: https://www.cms. gov/Outreach-and-Education/ Medicare-Learning-Network-MLN/ MLNProducts/MLN-Publications-Items/ CMS1243514.html 4.  Changing a Code for Reimbursement: Under HIPAA, Current Procedural Terminology (CPT) codes and their definitions are considered federal law. This means that the codes and their definitions are absolute. CPT states: “Select the name of the procedure or service that accurately identifies the service performed. Do not select a CPT code that merely approximates the service provided.” However, there are many times that providers change which code they use based on a denial or lack of reimbursement. For example, using CPT 97032 electrical stimulation (manual) instead of CPT 97104 electrical stimulation (unattended) when simply placing electrodes on a patient and setting the level of stim. Under CPT, 97032 requires “constant attendance” which means “The application of a modality that requires direct (one-on-one) patient contact by the provider.” Once the electrodes are placed on the patient, the nature of the modality does not require the provider to be present remainder of the service. By using the constant attendance code, the provider is misrepresenting what service they are actually providing. Another example is billing therapeutic exercises, CPT 97110, to more than one person at a time. CPT 97110 is a one-on-one code and requires that the provider maintain visual, verbal, and/ or manual contact with the patient throughout the entire procedure. One-on-one means that a provider must only be working with one patient at a time. Often providers will tell me they could see the patient doing the exercises while adjusting someone else – unfortunately this is not permitted. When the provider is treating more than one patient at a time, CPT 97150 - Therapeutic procedure(s), group (2 or more individuals) should be utilized. Conclusion: While these tips are not a substitute for a complete understanding of coding and reimbursement, the above items address a few of the top issues for coding and billing. Depending on your practice, making some simple changes to your coding and billing could make a big difference and help to avoid an audit and limit potential denials and recoupment. David Klein, CPC, CPMA, CHC, is the co-founder of PayDC, a web-based fully certified EHR system that focuses on compliance and reimbursement. He is a certified professional coder and auditor through the American Academy of Professional Coders (AAPC), and is certified in healthcare compliance through the Health Care Compliance Board (HCCB). He is the Founder and President of DK Coding & Compliance, Inc. a healthcare consulting firm that focuses on audit defense, education, compliance and reimbursement issues. ONLINE CHIRO VISIT ANJC.Aug2Free.com | CALL 866-792-5640 Promo Code ANJCSUMMER18 | Expires 9/30/2018 ANJC_Summer18.indd 1 7/13/18 2:50 PM