You can get paid for unlisted procedures, but the road is not always easy, mor eso in pain management and anesthesia practice. However, there are ways you can boost your chances of reimbursement.

You should make an effort to obtain pre-authorization from the payer in a letter. If you have clinical trials that have been conducted by recognized bodies of physicians, see to it that you include that information in your pre-authorization letter requesting approval for a pain management procedure for which you'll be using an unlisted code.

The letter should also include any current CPT codes that are similar in work and risk.

Study payer's policies for tips. Most medical policies that payers publish on their websites include disclaimers that every benefit plan defines what services are covered and what services are excluded. One of the things you want to keep up with are those policies payers publish on their websites. It may so happen that sometimes those policies can very much work to your advantage.

Keep a watch on employer plans. Payers often handle medical plans for employers. It is essential to check the patient's benefit plan for payment information even if the payer website says that the procedure isn't covered. Be prepared for a bit of a surprise as well because sometimes a specific plan may cover the procedure.

But in the end you should stick to the AMA official coding guidelines unless your contract with a payer stipulates otherwise. If you have any difficulty with a payer processing any unlisted procedure code, then you may take in hand the issue with the payer rep who may direct your provider that it's all right to report a CPT code breaking away from the AMA CPT guidelines.



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Documenting the various facts and figures is very much essential and unavoidable when you do a medical insurance claim. All data should be entered in a clear and precise manner. For this, the coder should be aware of the very many billing codes that are generally used during the procedural and diagnosis level. You can see the procedural codes in the CPT code book and the diagnosis codes in the ICD9 code books. Both are updated and published in a yearly basis. The CPT codes are published by the AMA (American Medical Association) from 1963 onwards and it was started because of the necessity of a standard to coding and terminology that was urgently needed.

Now from the passing of time 'medical coding' has become a complete arena by itself and these days you will be able to find many courses for teaching all about them. Almost all the insurance companies go by the individual codes and the coding industry has become of great importance. So we can see the true value of medical boding books and the significance of these books in the present world of medical insurance billing. Every year new version is given to these books and you must understand that insurance companies won't accept out-dated codes. If you by any chance happen to quote the out-dated codes there is every possibility of your claim getting denied!

Generally four categories of coding books are available like the CPT (Current Procedural Terminology), ICD9 (International classification of Diseases, HCPCS (Healthcare Common Procedure Coding System) and RBRVS (Recourse Based Relative Value Scale). You should be familiar with at least these four books in order to be a good and successful coder.

CPT code books contain the descriptions of the various services and procedures of physicians detailed using different CPT codes listed both in numerical and alphabetical way. Under each and every code, clear-cut explanations are given so that there are no ambiguities between the different services and procedures of physicians. Every year these codes are updated and coder should be aware of this fact. The CPT code books also contain a record of 'modifiers' which specify whether a service is modified or not. These AMA notified CPT modifiers are the 'two digit' numeric codes which are listed after the procedural codes.

As far as the ICD9 code books are concerned, they give the details of the coding system relating to the grouping and classifying of various diseases and covering the actual facts regarding them. Mainly these codes are employed in registering the incidence of medical diagnoses. Here also the listing is done both alphabetically and numerically and is updated annually.

HCPCS code books will give you the codes which are to be used with respect to the products, supplies and services which are not covered in the CPT code book. Some of the areas covered in this book are the ambulance services, durable medical equipments, and prosthetics/orthotics products. This code book also gives the coder an idea about the coding of the various materials which are used outside of the treatment place. This code book will be of much help to the insurance providers, the billing service centers who are doing the billing work for the providers, and agencies which offer services or supplies to the patient.

It is the RBRVS code book that determines the true value regarding the money paid to the medical facility providers including a physician is determined. Learning the latest version of RBRVS code book and acting accordingly is really a vital part in coding jobs. You must be always familiar with the renewed version of the RBRVS code book.



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Approximately half of people experiencing economic ruin in recent years are a direct result of medical problems and most of those people were covered by health insurance at the start of the illness. Medically related impoverishment involves more than 2 million annually. Often, the destructive illness led to job loss and therefore a loss of health insurance. As a result, one-third of those with private health insurance lost coverage by the time they lost everything else, too and needed to hire an Oklahoma City bankruptcy attorney. Researchers found that illness and medical bills were responsible for over fifty percent of those experiencing total financial ruin. When they have lost everything to paying off medical bills, who can afford to get the advice they need from an Oklahoma City bankruptcy lawyer?

Researchers concluded that a new approach to health reform is necessary. Health insurance cannot offer much protection for families when a serious illness brings with it co-payments, insanely high deductibles and bills for uncovered items like physical therapy and prescription drugs. Filing Chapter 13 is often the last resort for families to pick up the pieces and try to start their lives over.

Surely anyone in this country can appreciate just how fatally flawed the conventional health care system truly is. For the majority of the U.S. population, there is no good reason that health care should be as expensive as it is today. Aside from the rare situation where intensive costly intervention is required, most of us absolutely do not need to rely on expensive medications to treat chronic illnesses.

Some of the astonishing truths that the researchers uncovered are that 75 percent of the families who became impoverished had health insurance and about one-third had eventually lost their coverage by the time they had filed for Chapter 13. People who were slammed with the highest out-of-pocket costs were those who had medical coverage but lost it during the course of their illness. A government-funded, socialistic health care system may not be the answer, but patients, doctors, hospitals and insurance must start communicating and work out a compromise so that the needs of everyone involved are met.

Many are convinced that most of this financial devastation could have been avoided if conventional health care focused on treatments that actually address the cause of disease rather than prescribing and administering expensive, toxic and unnecessary cures. It is evident to us all that even if you have substantial health coverage, there is absolutely no guarantee that your finances will be protected should you come down with a serious illness. It cannot be stressed strongly enough that taking responsibility for your own health is one of the most important actions you can take today to protect not only your physical health but also your very financial security. We might do our best to speak out to our government and protect and improve our current state of health by becoming educated in how to live a healthy lifestyle. The keys are to eat natural foods, drink clean water, and get enough exercise and plenty of sleep every day.




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An anticoagulant is a substance that prevents blood from clotting. Anticoagulation therapy is extensively used to prevent and treat thromboembolic disorders. The four most common conditions for which anticoagulant therapy are used are atrial fibrillation, pulmonary embolism, deep vein thrombosis, and mechanical heart valves.

The first report of the clinical use of warfarin as an anticoagulant was made in 1941. Over the last few years, big changes have taken place in the area of anticoagulate management. New strategies have come into the picture and new indications have been identified for existing anticoagulants.

Anticoagulation management throws open a lot of challenges for coders and billers. Although AMA has specific codes for these services, Medicare still does not recognize them. So how do you get to know the right coding and billing options for anticoagulation management? And are you getting your rightful payment for anticoagulant management? If you're not getting them, don't give up.

Attend audio conferences and get the reimbursements you deserve for anticoagulate management. When you attend such conferences, you'll hear smart ideas on how to deal with payers so that you don't miss out on the monetary benefits. Other than that, theses conferences will teach you ways to avoid the top 5 compliance risks. If you have queries pertaining to anticoagulation management, you can go right ahead and ask the speaker.

These audio conferences are beneficial for coders, billers, and office managers in family practice, nurses, internal medicine, office managers, and others.

Moreover, the best thing about such conferences is that even if you miss out on one, there are CDs to take you through the entire event.

So go for an audio anticoagulation management conference and know how to stay away from problems that clot your anticoagulation management.



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