Do Medical Billing Codes Adapt to Medicine or Vice-Versa?

by  Find-A-Code™
Jun 1st, 2023

The medical coding and billing industry has its own chicken/egg question that goes something like this: do medical billing codes adapt to medicine or does medicine adapt to code sets? It is an interesting question that will probably never have a definitive answer. But from the AMA's perspective, their CPT codes evolve with the state of the healthcare system.

In the weeks leading up to the official launch of the 2023 CPT code update, the AMA released a series of informational and blog posts designed to prepare clinicians, coders, and billers. One such post, published in December 2022, discussed how CPT codes were being modified to keep up with digital technologies.

Increased Digital Adoption

There is no arguing that CPT codes need to be in line with how clinicians provide care. With new technologies come new procedures. Existing procedures can also be modified to take advantage of technological advances. This obviously stipulates that CPT codes be updated to account for the changes.

By the same token, it is well understood that clinicians might actively avoid certain procedures and services because they don't know how to bill for them. They sometimes treat patients by only offering services they know they can bill correctly.

Getting back to the technology issue, a 2022 study conducted by the AMA revealed just how quickly our healthcare system is embracing the digital revolution. Here are just a few key findings from that study:

• 93% of physicians believe there are advantages to adopting technology in healthcare
• 80% of physicians utilized telehealth in 2022, up from 14% in 2016
• 57% of physicians are enthusiastic about telehealth
• 40% of physicians have plans to adopt augmented intelligence in the future
• 20% of physicians already utilize augmented intelligence

It is clear that technology tools are changing the way healthcare services are provided. That takes us right back to the idea of medical billing codes having to change as well. Just the mere fact that so many clinicians are now enthusiastic about telehealth dictates the AMA needs to account for the technology in its CPT code updates.

Provider Investments in Coding

It seems pretty clear that CPT codes must adapt to modern medicine. But that's just one side of the story. The other side is the amount of investment providers put into their coding systems and procedures. By some accounts, providers and their billing department put so much time and energy into coding and billing that it becomes the driver.

There is some validity to such claims. When you consider that medical coders need to deal with tens of thousands of billing codes, it is easy to see how the complexity of it all can be overwhelming. Whether it is a hospital or private practice, a lot of what goes on in the back office is focused exclusively on coding and billing.

Such a strong emphasis on getting medical codes right bleeds into the actual provision of services. Clinicians need to be incredibly careful about the notes they take. They must be sure to use the right language, list the right things, etc. One little mistake could mean a rejected claim or significantly less revenue.

No Clear Answer

So, what's the deal? Do medical billing codes adapt to medicine or vice versa? There is no clear answer, and you could make the case for both. What we do know is that the current billing system relies heavily on codes and the people who wield them. A system that was intended to streamline medical billing has taken on a life of its own. We will leave you to decide whether that's good or bad.