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Ethics and Public Policy
April 2001

An Ethical Coding Perspective

Author Affiliations

From Jefferson Medical College, and Thomas Jefferson University Hospital, Philadelphia, Pa.

 

From Jefferson Medical College, and Thomas Jefferson University Hospital, Philadelphia, Pa.

Arch Facial Plast Surg. 2001;3(2):138-140. doi:

Facial plastic surgery is a unique milieu in which to practice. We do a variety of procedures for which insurance reimbursement is provided, many others for which no coverage is available, and a third group for which qualification for third-party indemnification may or may not apply, dependent on the indications in a given patient. This scenario gives rise to what I have come to call "coding anxiety."

Our legislators and regulators mandate that we charge the same fee for the same procedure regardless of the circumstances under which that service was rendered; to do otherwise is deemed discriminatory. The identifier for that service is the code we assign to it from the Current Procedural Terminology (CPT),1 and the basis for that assignation is the procedural description in this manual. Certainly, those descriptions are neither voluminous nor all encompassing, but they are generally specific with regard to the most important aspects of decision making. For example, some codes state that the harvesting of any graft that might be used in the procedure should be billed separately, while others state that the code " . . . includes obtaining graft."1

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