By Derick Perkins, Chief Strategy Officer, GoSource
Before Medicare pays for anything, they want to know why the patient needed help. This is where ICD-10 codes come in. These are codes for every diagnosis imaginable.
- The Rule: You must be specific. If a patient has a specific type of high blood pressure, don’t just use a generic “heart issue” code. The more specific the code, the more likely Medicare is to agree that the treatment was necessary.
-
The “What” (CPT and HCPCS Codes)
These codes tell Medicare exactly what you did during the appointment. Did you do a physical exam? Did you give an injection?
- The Rule: You must pick the code that exactly matches the service. If you bill for a “long, complex visit” but only spent five minutes with the patient, that’s a red flag.
-
The “Proof” (Documentation)
This is the most important part of the Medicare Billing Guidelines. There’s a saying in our industry: “If it isn’t written down, it didn’t happen.“ Your notes need to prove that the service you billed for was actually performed and was actually needed.
