Medical coding, a key factor of revenue cycle management needs to be accurate enough to ensure smooth reimbursement for healthcare providers. Medical coders take information from the medical record documentation and assign appropriate diagnoses and procedure codes. Accurate coding of claims also requires correct clinical documentation from healthcare providers. Experienced medical billing companies provide the services of skilled medical coders, who stay up-to-date with the changing coding guidelines and insurance standards. Along with providing the correct codes and accurately verifying patient details, coders can follow these tips to improve their coding practices. You can also listen to our podcast on key medical coding errors.

Adopt checklists

Medical coding professionals focus on documenting diagnosis, treatments, and results in the form of ICD-10, HCPCS and CPT codes on insurance claim records. Adopting checklists can help these professionals improve medical coding accuracy. It –

  • Reminds coders of additional characters, action and add-on codes, and modifiers that should be reported

  • Helps avoid distractions, resulting in an error in the claim

  • Alerts coders of all crucial federal tracking codes

  • Can improve communication in operating rooms between providers, nurses, and other staff

Review of Systems

Review of systems (ROS) refers to an inventory of body systems obtained by asking a series of questions to identify signs and/or symptoms the patient may be experiencing or has experienced. Such queries made verbally by the physician or hospital staffs, or through patient intake form helps to check the requirement of extended examination and testing. For ROS, 14 systems are recognized including eyes, cardiovascular, respiratory, musculoskeletal, psychiatric, endocrine and more. Documentation includes signs and symptoms of the condition and often auditors commonly watch for indicators of a question that has been asked by the physician or provider and answered by the patient.

Appropriate use of modifiers

Modifiers are required for certain CPT and HCPCS codes. These two-digit codes provide additional information about the procedure performed. These can also be used to identify the body area where the procedure is performed, such as modifier RT for “right side” and LT for “left side”.

Recently the Centers for Medicare & Medicaid Services (CMS) issued a policy change for Modifier 59 Distinct procedural service and the optional patient-relationship modifiers XE, XS, XP, and XU. Starting July 1, 2019, CMS has accepted to process modifier 59 when it is used on either the column 1 procedure or the column 2 procedure. The CCI bundling edit will be bypassed when modifier 59, XE, XS, XP, or XU is used on column 1 and column 2 codes. Note that this policy change does not affect Medicare Managed Care payers, Medicaid, or commercial payers. Recently some non-Medicare payers, such as Horizon Blue Cross Blue Shield have indicated that they recognize these modifiers.

Pay attention to operative reports

While coding, make sure to read the pre- and post-operative reports (OP). Instead of coding from the pre-operative diagnosis, code from the post-operative diagnosis that provides details such as why the procedures were performed, what the physician discovered during the operation and the area where the physician performed the procedure. It is also recommended never to code from the title of the procedure. Also, review the indications sections of the OP report that provides details such as the disease or condition that created the need for the surgery, any indication that the patient is subject to an existing global period and indications that this may be a more difficult procedure.

Code the correct procedure and medical coders can also query the physician if any details are uncertain. Also ensure that the OP report matches the patient.

Check NCCI edits

The CMS has developed the National Correct Coding Initiative (NCCI) to promote national correct coding methodologies and to control improper coding leading to inappropriate payment in Part B claims. While reporting multiple codes, coders must make sure to check these NCCI edits, which analyzes every pair of codes to see if an edit exists. NCCI includes three types of edits – Procedure-to-procedure edits, Medically unlikely edits (MUE) and Add-on code edits. NCCI Procedure-to-Procedure (PTP) edits prevent improper payment when incorrect code combinations are reported. If there is an NCCI edit, it means a code is denied.

By outsourcing medical billing and coding tasks to an experienced medical billing company, healthcare providers can focus on providing optimal care to patients and stay competitive in the industry without any worries about claim submission and reimbursement.