US Coding and Reimbursement

Abstract

Vascular surgical practices focus, in the treatment of ruptured abdominal aortic aneurysms (AAAs), on patient presentation, operative care, post-procedure management, and quality outcomes. Despite the importance of these issues, continuous assessment of the process by which care is rendered in order to optimize billing, coding, and ultimately reimbursement remains essential as well. The billing department in each medical practice produces an insurance claim for each medical provider by linking a diagnosis code with a procedure code and adding modifiers as needed. Typically, claims are submitted to the insurance carrier electronically. The appropriateness of this coding translates into timely reimbursement for the practice. Each time a submission is rejected for any reason, the chance of that service ever being paid to the physician decreases significantly. Therefore, the ultimate goal is to generate a claim that is without error, medically appropriate, and correctly describes the intervention. This chapter should be used only as a guideline for the physician and coder since each insurance payer has their own rules and regulations.