I will start by saying...read the code descriptions for each. The codes are distinctly different, and your provider should report the code that best describes the procedure performed. I caution you on substituting one code for another. Insurance carriers have the right to alter payment based on policy provisions and the codes submitted but as a provider or staff, we do not have that luxury of altering what is reported. Coding based on coverage and not what was performed may cause claims submissions that are not entirely accurate AND/OR violate contractual language. Also remember that we want to always ensure that documentation and billing records are in sync.
