Oops! I accidentally used the wrong CPT code on a claim

Running a practice involves juggling a lot of balls – from providing excellent client care to managing the administrative side of things.  And sometimes, in the midst of all that, a little slip-up happens, like entering the wrong CPT code on an insurance claim.  If you’ve ever felt that little jolt of panic when you realize you’ve entered the wrong code, take a deep breath. You’re not alone, and more importantly, it’s fixable! This blog post is your guide to navigating this little bump in the road and getting things back on track. Let’s walk through the steps together. 

1. Acknowledge and assess: It’s okay, we’ve all been there

First things first, it’s important to acknowledge the mistake. Don’t beat yourself up about it; it happens to the best of us! Now, take a moment to assess the situation by asking yourself: 

• Which CPT code was used? 
• What should the correct code have been? 
• How big of a difference does this code make? Will it significantly affect how much you get reimbursed, how much your client pays out-of-pocket, or how the session is ultimately documented? Some code errors are small tweaks; others are more substantial. 
• What service did you actually provide? Make sure you have your session notes and treatment plan handy to refresh your memory. 
• When did the session take place? This will help you confirm the date of service for any corrections you need to make. 

Understanding the impact will guide your next steps and help you gauge the urgency of the situation. 

2. Reach out to the insurance payor (sooner rather than later)

Once you’ve identified the error, don’t delay – reach out to the insurance company as soon as possible. A phone call is often the quickest way to get the ball rolling.  Most payors have timely filing limits, meaning you have a specific window to correct claims.  Here’s how to approach this conversation: 

• Be prepared. Have the following information readily available:  
  • Your provider information (NPI, tax ID, etc.) 
  • The client’s information (name, member ID, date of birth) 
  • The date of service 
  • The incorrect CPT code you used 
  • The correct CPT code 
  • A brief, professional explanation of the error– a simple, “I inadvertently used the wrong CPT code and need to submit a corrected claim” works well. 
• Document everything. Note the date and time of your call, the name of the representative you spoke with, what you discussed, and any instructions you were given. You might want to save their email address in case they’re able to help you further. 
• Be collaborative and transparent. Let them know you’re committed to correcting the error and providing the necessary information. Honesty and open communication can go a long way. 
• Ask about their process: every insurance company has its own procedures for correcting claims.  Ask them: 
  • Do they accept corrected claims electronically or do they need a paper form? 
  • Is there a specific form required for corrections? 
  • What is the timeframe for submitting corrected claims? 
  • Do they require any specific documentation to support the corrected claim, such as session notes? 

You may have to send in additional documentation, such as progress notes or treatment plans, to support your claim correction. This isn’t a bad thing; it’s often just a part of the process!  

3. Tap into your network: Don’t be afraid to ask for help

If you’re feeling unsure about how to proceed, don’t hesitate to ask for help! This is where your professional network can come in handy. 

• Billing expert: if you have a billing expert in your practice or work with a billing service, they are your go-to resource. They’ve seen it all and can guide you through the process with confidence. 
• Supervisor or colleagues: your supervisor or trusted colleagues can also be a great source of support and advice. They may have encountered similar situations and can share their experiences and strategies. 
• Professional associations: many professional associations offer resources and support to members dealing with billing issues. Check their websites or reach out to their member support teams. 
• Informal networks: if you’re in contact with other therapists (like Facebook groups, reddit threads, or co-working sessions), ask them if they’ve been there and how they got out of it. They might have helpful advice. 

You’re not the only person to make this mistake; you won’t be the last. That means other people have solved this problem and have a blueprint for solving it. 

4. Request a correction: Get that claim back on track 

Now, it’s time to officially request a correction. Depending on the insurance company’s policies, this might be done in one of a few ways: 

• Claim adjustment or re-billing: you might need to submit a corrected claim (also sometimes referred to as a “replacement” claim), clearly indicating that it’s a correction of a previously submitted claim. Make sure you use the correct filing type code or other indicator the insurance company uses to signify an adjustment or rebilling. You’ll likely need to include a brief explanation of the correction.  

Sometimes, the payor might allow you to simply adjust the existing claim. This is often easier but may not be possible in all situations.  Your contact with the insurance company will help you determine which route is best. 

• Void and resubmit: in some cases, the insurance company may require you to “void” the original claim and then submit a completely new claim with the correct information. 
• Overpayment refund: if the incorrect code resulted in an overpayment, the insurance company might ask you to refund the difference or apply it as a credit to a future claim.  
• Be diligent:  double-check all the information before submitting the correction.  Pay attention to deadlines. Insurance companies typically have specific timeframes within which you can submit corrections. 

5. Track and follow up on the claim

Once you’ve requested the correction, the process isn’t quite over. Now comes the important part of tracking and following up. 

• Track the claim: use the payor’s online portal or call them to check the status of the corrected claim. 
• Note any changes: compare the reimbursement to what you expected based on the correct CPT code. 
• Keep meticulous records. Track the date you requested the correction, any reference numbers provided by the insurance company, and copies of any documentation you submitted. 
• Follow up regularly. Don’t let the corrected claim disappear into the system. Check in with the insurance company periodically to ensure they’re processing it. A simple phone call or email can go a long way. 
• Don’t be afraid to escalate. If you’re not getting a response or if the process seems stuck, don’t hesitate to ask to speak with a supervisor or file an appeal, if necessary. 
• Communicate with your client: keep your client informed, especially if the error affects their out-of-pocket costs. A simple explanation and assurance that you’re handling it goes a long way. 
• Celebrate a win! When you finally see that the corrected claim has been processed, give yourself a pat on the back! You navigated the process like a pro. 

6. Learn from the mistake (prevention is key)

Okay, so the claim is fixed – whew! Now, let’s talk about preventing future errors. 

• Double-check your codes: before submitting any claim, take an extra moment to verify that the CPT code accurately reflects the service provided. 
• Stay updated: CPT codes are updated annually.  Make sure you have the most current code set and are aware of any changes. 
• Use cheat sheets or resources: create a quick reference guide for the most common CPT codes you use. Many organizations offer these as well. 
• Consider EHR features: if you’re using an electronic health record (EHR) system, take advantage of any built-in tools to help with coding accuracy.  
• Ongoing training: regularly review billing and coding practices with your team. 

How Ensora Mental Health helps therapists avoid billing mistakes 

Billing can be one of the most challenging aspects of running a practice. That’s why Ensora Mental Health simplifies your billing process and reduces the chances of making these kinds of errors in the first place. Here’s how: 

CPT code and modifier guidance 

Ensora Mental Health provides built-in guidance on CPT codes and modifiers, so you can confidently select the right codes.  Our system is regularly updated to reflect the latest code changes, so you don’t have to worry about using outdated information. We integrate the latest CPT, ICD-10, and DSM-5 codes, keeping your billing compliant and current. 

Billing alerts and notifications 

Ensora Mental Health’s intelligent system includes alerts and notifications that can catch potential errors before you even submit a claim.  For example, if you enter a code that seems inconsistent with the service type or session duration, you’ll get a heads-up. This proactive approach helps you review the coding information and correct mistakes before claims are rejected. 

Claim rejection analysis 

Even with the best systems in place, mistakes can still happen. If you do need to correct a claim, Ensora Mental Health makes the process straightforward. You can easily create corrected claims, add necessary documentation, and track the status of your resubmissions. 

Support and resources 

We’re here to support you!  Ensora Mental Health provides a wealth of resources to help you master the world of insurance billing.  This includes comprehensive documentation, step-by-step guides, and even e-books on how to avoid common billing mistakes.   

Need extra support? Consider managed billing 

If you’re still struggling with complex billing issues that hinder your practice from reaching its true potential, consider managed billing. You can outsource most of your billing tasks to a team of insurance billing experts, who will take the burden off your shoulders and help you improve your practice’s financial health. Learn more about managed billing.  

Final thoughts: You got this

Using the wrong CPT code can feel daunting, but remember, it’s a common mistake that can be corrected. By taking prompt action, communicating effectively, and utilizing the resources available to you, you can resolve the issue efficiently and continue providing top-notch care to your clients. And with tools like Ensora Mental Health, you can minimize future billing mishaps and focus on what truly matters: your clients’ well-being. We’re here to support you on your journey! 

Ready to experience stress-free billing?  Empower your care and take back precious hours in your day-try Ensora Mental Health for free. We offer a free 21-day trial of Ensora Mental Health, no credit card required.  See for yourself how our features can boost your billing accuracy and give you more time to focus on what matters most – your clients.