Current Procedural Terminology (CPT) is a useful tool for streamlining the medical information technology. These CPT codes are continually reviewed, revised and updated to reflect changes in health care. There are three types of CPT code -- Level I, II and III.

Understanding the CPT coding is particularly important for employees of records, billing and insurance firms, who do not possess any medical training but depend on their knowledge of the CPT code for their work.

If you want to enter the medical coding world and need to have a good understanding of CPT coding, here's what you can do:

* You can spot these code on discharge paperwork, on bills from health care providers and from "explanation benefits" paperwork from Medicare and insurance companies. So get hold of paperwork to have a better understanding of these CPT codes.
* You can usually find the CPT code next to all entries for any service performed. Normally these codes will either be entries of 5 digits or 4 digits and a letter.
* If you want an explanation of what each procedure entails, go to the physician's office. Here your local physician will be able to help you match the CPT codes to specific services.
* The customer service at the insurance company will also be able to explain to you what each CPT code means and what services were provided.
* You can get the entire CPT code list at American Medical Association's Website Knowing the CPT codes inside out before embarking on a medical coding career will do you a world of good. So get going.



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Spinal instrumentation is a method of keeping the spine stiff after spinal fusion surgery. It is used to treat the deformities of the spine owing to birth defects, fractures, scoliosis, spine diseases, and other injuries. When the spine no longer maintains its normal shape, and nerve damage occurs, different kinds of instrumentation (made of metal/titanium) are inserted into the spine. The instrumentation is typically comprised of pedicle screws, rods, plates, intervertebral cages, hooks and rods.

Guidelines in spinal instrumental coding: New techniques and technologies for spinal instrumentation are moving faster than codes can keep up. What's more, procedures come in a variety of configurations, which are often puzzling. While coding, these procedures could prove to be tricky. In a nutshell, unique coding guidelines and billing requirements for spinal instrumentation test the knowledge of even the most experienced neurosurgery coders.

So, if you want to be on track the next time a spinal instrumentation procedure hits your desk, you'll do well to attend quick and convenient audio conference that will coach you on what you need to know about spinal instrumentation coding. What's more is that you'll walk away with the know-how to determine proper reimbursement and avoid any inappropriate payment denials.

Audio conferences will also help you get the low down on spinal anatomy and definition, common types of posterior and anterior instrumentation and how they translate to codes, real life examples of instrumentation coding, new technologies and the latest codes, and so much more.

Neurosurgeons, orthopedic surgeons, coders and billers, office managers and compliance officers, health insurance company claim processors - will all return enriched after attending these audio conferences.



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Everyone knows denials and documentation requests reduce the value of your chiropractic claim and frustrate your billing department. To get paid on time and in full, be sure you avoid the following common errors in your chiropractic coding and billing:

1. Modifier Failures. Depending on which procedure code you use, a modifier may be appropriate. In Medicare, for example, you need to indicate whether the service represents Active Treatment (using the modifier -AT) or it will not be paid. Similarly, performing Manual Therapy (97140) on the same visit as an adjustment will also require a modifier to be present to signify that it was a separate and distinct service (Modifier -59).

2. Stagnant Adjustment Codes. Billing for a 5 region adjustment (98942) on every visit just because you are a full spine doctor will not sit well with most insurance companies. From the viewpoint of the insurance company, it is statistically improbable that every one of your patients needs an adjustment from top to bottom every visit.

3. Routine Use of Full Spine X-rays. This is another easy red flag for an insurance company to spot and it follows the same logic as the previous entry. If other practitioners all take x-rays in a wide variety of anatomical regions, but every one of your x-rays is a full spine series, then you suddenly stand out from the rest of the pack and are essentially inviting an auditor to investigate your billing and coding practices.

4. Billing for an E/M Code on a Daily Basis. Some shady chiropractic "coaches" and practice management gurus advise their clients to increase services through the repeated, routine (or even daily). Unfortunately, anyone with a knowledge of proper coding practices will tell you that this is not warranted and will just lead to big trouble when the insurance company catches on.

5. Billing for all New Patients With a High Level E/M Code. Certainly, high level E/M codes such as 99204 or 99205 reimburse the most. But there are probably few (if any, in certain chiropractic offices) times when an exam truly meets the criteria of these codes. To simply bill these codes in hopes that it will fly under the radar is foolish and misguided at the least and possibly fraudulent as well.

Hopefully, this "red flag list" will serve as a reminder of some of the poor practices that will get you audited by a third party payer. If you are a chiropractic office that is actually utilizing one of the above billing or coding practices in your office, let this article be a warning that your current procedures have you headed for trouble. My advice would be to correct any of the actions necessary immediately and/or get experienced help quickly. There are many ways to get paid for your services through proper chiropractic billing, coding and documentation; utilizing some of the above methods will only get you in trouble over time.


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Insurance carriers often deny claims for not being coded to the highest level of specificity. As many billers are not coders they often don't understand what has gone wrong or how to fix it.

If a service line is denied for this reason they are saying that the diagnosis code needs to be more specific. Some diagnosis codes are only three or four digits but many are five digits. The diagnosis must be coded to the absolute highest level for that code, meaning the most number of digits for the code being used.

For example, the diagnosis for hypertension begins with 401. However if you submit a cliam with the diagnosis 401 it will be denied. The code 401 requires a 4th digit. 401.0 is malignant essential hypertension. 401.1 is benign essential hypertension. 401.9 is unspecified essential hypertension. So to bill a claim with a diagnosis of hypertension it must be either 401.0, 401.1, or 401.9.

Another example of a diagnosis needing to be billed to a higher level of specificity would be diabetes. 250.0 indicates diabetes however you neeed a 5th digit to specify what type of diabetes. 250.00 is diabetes mellitus type two, 250.01 is diabetes mellitus type one (juvenile type), and 250.02 is diabetes mellitus type one uncontrolled and so on.

As you can see in the above example just putting 250.0 does not indicate specifically what the problem is. Without the fifth digit the claim is lacking enough information to be processed and therefore will be denied.

If you are unsure if the diagnosis is coded to the highest level of specificity you can look it up in an ICD9 code book or on the web. There are several websites with current ICD9 codes available. They will indicate if the code is coded to the highest level.

Some practice management systems have scrubbers that will catch under coded diagnosis and give you a warning. Sometimes the biller may recognize a truncated diagnosis (or a diagnosis requiring an additional digit.)

In either case the biller should go back to the coder or provider and ask them to be more specific with the diagnosis code so the claim can be resubmitted.



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