Upcoding: This is when you use a CPT code that represents a higher-priced treatment or a more severe diagnosis.Regardless of the reason it is done, undercoding is illegal. Providers may also undercode to avoid auditing from an insurance company. A provider intentionally leaves out a service rendered as a way to save money for the patient. While this can be done by mistake, undercoding is often intentional. Undercoding: This is when you use a CPT code that represents a lower-priced treatment or a less severe diagnosis. Two of the most common mistakes when it comes to CPT codes and medical billing is undercoding and upcoding: Using the wrong CPT code can be detrimental for your pay cycle in specific and for the health of your practice in general. CPT codes and add on codes are used to convey the exact service you provided to your client and from there they eventually determine how much you are paid. Whether you bill directly to insurance companies or you provide your clients with superbills, having the correct CPT codes is necessary if you want to get paid in full and avoid an insurance audit. These five-digit codes are used to quantify any treatment a client relieves whether that be a trip to the ER or a therapy session. CPT codes describe the action taken or the treatment provided to clients. To put things into perspective, the last time the codes were changed before 2013 was in 1998 (meaning you really only will need to learn the CPT codes you use once). The CPT codes for psychiatry, psychology, and behavioral health underwent a revision in 2013 and aren’t scheduled for another revision anytime soon. This is a standardized set of codes published and maintained by the American Medical Association (AMA). But what do they actually mean? CPT stands for Current Procedural Terminology. ICD and DSM and CPT, Oh My! You’ve probably seen or at least, heard of each of these terms before.
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