Module # 2

In the operating room the nurses use medical terminology for nearly every treatment and procedure. The billers use the ICD-9 codes to appropriately bill for treatments and procedures. The billers often ask me to help them determine how to correctly interpret an ICD-9 code for correct billing and sometimes it is really hard to make a judgement on what code is the most appropriate. For instance, we did a brain surgery and there were two codes to choose from. One of the codes would charge $22, 000 and the other would charge $82,000. The description of the procedure for the codes were so similar that it was hard to decide which was more appropriate. The only reason that I was able to help them choose which charge was more appropriate is because I had been in on the surgery and knew it was a less complicated surgery and qualified for the $22,000 charge. There are many other cases that are similar and the billers really struggle to make sure the codes are correct.