Stranger Danger: Evaluating Coding Advice from the Web

by Gail I. Smith, MA, RHIA, CCS-P

Go to the web and search for a procedure, any procedure will do but type the phrase CPT code in the search box. Chances are you will receive advice from a variety of sources. You may think to yourself, that was so easy. The question becomes, can you trust this advice?

While developing content for an upcoming advanced CPT training course, I was searching the web for resources related to a procedure. Among the responses was a coding recommendation supported by a comment: “we submitted this code and it got paid.” This type of rationale makes me cringe and causes concern about the data mess we have in this country.

Medical organizations and others have expressed alarm at the blind acceptance of “incorrect coding guidance” being published on the web. I recently came across a pointed statement posted by the American College of Surgeons (ACS), the American Society of Colon and Rectal Surgeons (ASCRS), and the Society of American Gastrointestinal and Endoscopic Surgeons (SAGES):

Faced with this uncertainty, who can you trust and how can you leverage web-based searches to report accurate CPT coding of procedures? The following list will reveal some of the resources available for coding professionals:

• CPT Assistant and Coding Clinic for HCPCS: Both publications provide official advice; unfortunately both are only available through a subscription. When using these resources, note the most current date for published information, sometimes they provide clarifications which may or may not conflict with an earlier decision.
  • CPT® Assistant is the official newsletter that educates the industry on proper CPT coding for past, present and future code set releases.
  • Coding Clinic for HCPCS brings the latest official coding information on Level I HCPCS (CPT-4 codes) for hospital providers and certain Level II HCPCS codes for hospitals, physicians and other health professionals.
• Centers for Medicare & Medicaid Services: Medicare issues a plethora of coding advice through publications such as Medicare Claims Process Manual, policies and memorandums. Although the information is open-source (no subscription necessary) searching is cumbersome; therefore, many healthcare providers subscribe to online services and incorporate software solutions to remain current. If the patient is not insured by Medicare, another set of coding guidance may be needed based on carrier-specific policies.
• Medical Societies: Some of the medical societies offer open-source coding advice such as CodingToday, sponsored by the American Urological Association. Unfortunately, some medical society resources are locked behind a subscription service model.

No Easy Answer
If a coding professional has a lot of time to research and a budget that provides access to up-to-date published coding guidance and/or software solutions then the daily struggle may be minimal. For the rest of us, with more limited resources, “finding an answer on the web” has become common practice.

My advice is to seek out guidance from individuals or organizations who have the experience to provide clear and detailed coding advice supported by documentation and rationales for their recommendation. While a coding answer from the web can go on your list of possible choices it must be verified based on the operative report or clinical picture and tested against your knowledge of the CPT system.

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