The Evolution and Impact of CPT Codes: A Comprehensive Guide
Current Procedural Terminology (CPT) codes are an integral part of the healthcare industry. They provide a standardized language for medical, surgical, and diagnostic services, enabling clear communication among healthcare providers, patients, and insurers. This article will delve into the history, current use, and future of CPT codes, with a particular focus on their application in Applied Behavior Analysis (ABA) therapy billing. A Brief History of CPT Codes. What Are CPT Codes? The American Medical Association (AMA) introduced CPT codes [...]
Transitioning from HCPCS to CPT Codes in ABA Services: A Practical Guide
In the world of medical billing, change is the only constant. As healthcare evolves, so do the systems and codes used to bill for services. One significant shift that practitioners in the field of Applied Behavior Analysis (ABA) may encounter is the transition from Healthcare Common Procedure Coding System (HCPCS) codes to Current Procedural Terminology (CPT) codes. This transition can be complex and daunting, but with the right knowledge and resources, it can be managed effectively. This article provides [...]
How To Handle Unlisted Codes To Prevent Denials
The healthcare industry continues to evolve with new services, care devices, medications, and treatment techniques being developed each day. These advancements are entering the field faster than ever before. Many of them have new CPT codes affecting their use and applications. Yet the American Medical Association (AMA) can sometimes take as much as 18 months to 2 years to come out with modified CPT codes and instructions for some of these new advancements. This can lead to a plethora [...]
What Is CPT Code 99284 & How To Know When To Use It
Errors in medical billing codes tend to be one of the most common reasons that a claim is denied or rejected by mental and behavioral health payers. Not only can this lead to massive delays and inconsistencies in your practice’s revenue stream, but it can cause other long-term complications. A solo practitioner or a small practice that has frequent medical coding errors can sometimes draw a red flag from a private insurance company, public health institution, or another type [...]
What Is CPT Code 99202 & How To Know When To Use It
Knowing when and how to correctly apply a CPT code is one of the most challenging aspects of mental health insurance billing. It typically requires the memorization and correct application of a staggering array of CPT codes. For a lot of solo practitioners, small practices, and ABA therapists, knowing exactly when to use a specific CPT code and in what situation can feel daunting. Yet accuracy is exactly how providers secure prompt payment from a “Clean Claim” that is [...]
What is CPT Code 97151 for ABA Therapy?
After August 1st, 2021 all authorizations requested on or CPT code 97151, for assessment and treatment plan development, need to be authorized for up to 32 units. This translates into a total of 8 hours for an initial assessment, which is broken down into 24 units, comprising up to 6 hours for all subsequent authorization periods. Though it’s also worth noting that CPT code 97151 still needs to be conducted over 14 calendar days or less. This means that [...]
99211 CPT Code Use Case Scenarios For ABA Therapy
CPT codes play a critical role in medical billing. Using the wrong code in the wrong place or for an incorrect type of diagnostic or treatment process can lead to potential claim rejections and denials. Not to mention a very serious risk of delays in your practice’s revenue stream. One of the CPT codes that come under scrutiny by some insurance providers and public health institutions is the 99211 CPT code. Though knowing precisely when to use this 99211 [...]
What Is A Medical Coder And What Do They Do?
Accurate medical billing plays a critical role in ensuring that physicians get paid consistently and at a reimbursement level that is appropriate for their credentials, the type of treatment administered, and any specialist services they offer. Of course, this reimbursement also affects their ability to do other essential things like pay administrative staff, update their medical equipment, purchase new medical supplies, and even pay their in-house administrative staff. Errors and missing information in a claim that’s accidentally submitted to [...]
Top ICD-10 Codes for Mental and Behavioral Health
Accurately medical billing is not an easy task for a lot of small practices and solo practitioners. The wide range of evolving terms and acronyms used for even the most simple of services can be exceedingly complex. An incorrectly used code or even a simple piece of missing information can lead to significant delays in your revenue stream as well as increasing the risk for a claim rejection or claim denial. As the various code books continue to evolve [...]
New 2021 E/M Coding Changes You Should Know
Every year payers and public health institutions like the Centers for Medicare and Medicaid Services and the American Medical Association implement changes to their Evaluation and Management coding. Like clockwork, these changes were implemented on January 1, 2021. Physicians and medical practices of every scale need to educate themselves and their staff on these changes to minimize any delays and reduce the risk for potential questions when filing a claim or requesting prior authorization. This also helps ensure that [...]
