Interpretation of CPT codes may differ among funders and providers alike – from one another, and from their intended use as approved by the AMA.
Needless to say, it’s important to access and understand source documents. The ABA Coding Coalition website (linked below) and your funder agreements are central in this regard.
Understanding the intended interpretation as well as how each of your funders interprets them (and your contractual obligations) is important, and can help mitigate liability and keep you out of some 🔥 water to say the least.
Here is the link for the Coding Coalition’s website: https://abacodes.org/. Through it, you can access valuable resources, submit a question directly to a representative of the coding coalition, read about the codes as they were intended and approved by AMA, access their FAQ sections, and learn more about them and related advocacy efforts.
Here are some other important things for ABA practice leaders to consider:
✔ Make sure you have a solid understanding of the intended use and interpretation of the codes.
✔ Understand each of your funder agreements and how they may differ from intended use of the codes.
✔ In deciding whether to start or continue to work with any given funder, make informed, budget based decisions with this information in mind – there are financial implications to accurately or inaccurately interpreting the codes.
✔ Have job aids or other ways to ensure and monitor compliance.
✔ Consider (3rd party) audits or other approaches to help ensure compliance as part of your ongoing activities.
Any other things to add to this list?
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Need help with these things? Partners Behavioral Health can help.
Brandon Herscovitch, Ph.D., LABA, BCBA-D
