nasal vestibular stenosis. That's not correct. You should use HCPCS
code C9749, a code for a far less extensive procedure. Remember, the
CPT code is based on the amount of time and work a procedure is
expected to take. Many of today's new devices and technologies great-
ly reduce the time and surgical effort it takes to perform a procedure.
Ignoring your carrier policy. If you outsource your billing to a
third-party firm, keep in mind that the billing company's job is to
maximize reimbursement on each case that it bills. However, the
billing practices must follow the policies of the carrier with which
you've contracted. For example; if you have specific procedures —
say a glaucoma stent procedure — that your major carriers such as
Aetna and Cigna consider experimental, then it stands to reason that
many of your other carriers will follow suit. It's incumbent upon your
billing company to determine every carrier's payment policy.
Remember: Billing is a specialized field, not just a data-entry position.
What you can do
Here's what you can do to ensure your facility doesn't fall victim to
the reimbursement traps that have ensnared so many of your peers.
• Go to the source. CMS determines Medicare reimbursement, and
the agency offers an invaluable and underutilized guide to help you
see exactly how they do it: the National Correct Coding Initiative
(NCCI) Policy Manual for Medicare Services (osmag.net/forms). For
each section of the current CPT manual, the NCCI manual details
which CPT codes you can report together and which ones you can't.
This guide essentially tells you what you can and can't do in terms of
coding, so it's an indispensable tool to prevent incorrect billings to
Medicare.
• Stay on top of code changes. As you know, codes are frequently
3
Coding & Billing
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