Medical Assistant Students Frustrated About Medical Coding Expectations

Can These Two CPT Codes Be Billed Together?

Medical assistant students enrolled in medical assistant courses often have difficulties understanding the medical billing claim form and have problems understanding evaluation and management codes. We often hear from frustrated students; many wind up venting on one of our active forums.
A medical assistant student recently posted that her instructor wasn't very helpful while teaching the administrative medical assisting module; she felt the instructor apparently wasn't well versed in the medical billing and coding process herself and therefore was unable to explain the process in a manner that made it clear to the class. The students are frustrated and overwhelmed. Another one posted in the forum: I work for a cardiologist. We are trying to get clarification on the following...

QUESTION:

Can these two codes be billed together if both of these services are performed?

• CPT 93454 (Catheter place in coronary arterty(s) for coronary angiography, imaging supervision, and interpretation.)
• CPT 93458 (with left heart catheterization including intraprocedural injection(s) for left ventriculogy, when performed.

Another question that is often raised in our medical assistant forum is why medical assistant students should have to learn medical coding and billing in the first place, and why it is such an extensive part of the medical assistant certification exams.

I have received emails from frustrated medical assistants who contacted me right after taking their certification exam, where they state that they were totally stumped on the many medical coding questions in the exam. They encountered questions that were multiple choice and asked about specific numeric codes, or modifiers for a given specific diagnosis, or procedure.

Now, ask any medical assistant to give you a specific code without any reference book/manual and he/she would be hard-pressed to give the right one, since there are so many, not to mention specific modifiers. There are codes for evaluation and management from 99201 - 99499, such as 99201 - 99215 for office and other outpatient services; codes for anesthesia from 00100 - 01999, such as 00100 - 00222 for the head; codes for surgery from 10021 - 69990, such as 10021 - 10022 for general, and 60000 - 60699 for the endocrine system, Category II CPT Code(s) – Performance Measurement (optional), Category III CPT Code(s) – Emerging Technology (Category III codes: 0016T - 0207T, to name just a few.

We also heard from a physical therapy instructor who teaches basic medical coding and billing as it pertains to PT because the majority of his students do their own billing and coding, who is equally frustrated at times, not knowing the exact codes and how to apply them.

Do Medical Assistants Really Need Medical Coding Skills?

I can see where medical assistants need to have an idea of medical practice financial management, such as banking deposits, accounting and bookkeeping, dishonored check processing, payroll - and even that is nowadays often outsourced. Nevertheless, in any profession you should get a picture of how the whole kit and caboodle functions to make it run.

I think, as far as medical assistant students are concerned, it is okay to briefly introduce them to the billing and collections process to give them a general understanding of how things work. The medical assisting instructor should also provide commonly used standard forms, such as laboratory requisition slips, which often already have CPT codes already printed on them, a Superbill, health insurance claim forms, medical history, and HCFA-1500 forms for the students to fill out, and practice. This way, they can better address patient questions and communicate with the medical billing and coding staff efficiently should certain issues arise.

However, as far as spending a great amount of time looking up CPT and  ICD-9 codes and drilling billing and coding procedures, and assigning specific codes from memory to procedures, diseases and injuries from memory in final exams, from my perspective as a former working medical assistant and medical assistant program instructor, it seems redundant.

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