Medical billing is an important process from the point of view of practice revenue, and it has to be accurate. Coding mistakes can lead to claim denials and delays from insurance companies. Therefore, it is necessary to take appropriate measures to ensure that coding mistakes are avoided. Here are the top 10 coding mistakes that may occur in the course of medical billing.
Using Old Coding Books
Coding books are required to perform medical coding perfectly. Coders often make the mistake of using old coding books for this purpose. Using software built with old coding guidelines and reference materials can lead to grave coding errors.
Not Noticing the Editorial Comments in the CPT Book
Coders, billers and physicians often come across a number of vexing questions regarding various types of medical services. The editorial comments in each section of the CPT book usually have answers for all these questions. Coding mistakes will reflect in medical billing if these comments are ignored.
Absence or Misuse of Modifier 25
When a separate, identifiable Evaluation and Management (E/M) service is carried out as a procedure during the same day, then modifier 25 is used to record it. If it is not added to the relevant E/M service or added mistakenly to a surgical procedure, then the claim corresponding to the service will be denied.
Confusion between Modifier 51 and 59
Modifier 51 can be used to report multiple procedures performed on the same day by the same physician. It cannot be used for “add-on” codes, and it cannot be used along with an E/M code. Modifier 59 signifies a distinct procedural service provided on the same day along with other procedures/services. It is used to report procedures/services that are not usually reported together, but are appropriate under the particular circumstances. Use this modifier only when no other descriptive modifier is available, and its use best explains the circumstances. This modifier cannot be used for an E/M code.
Cannot Link CPT and ICD-9 Codes
CPT coding is used for determining the fee levels for physician services. But, it is possible for payers to deny the claims on the basis of inappropriate diagnostic codes or ICD-9 codes. The coding will be erratic if the clinicians fail to link the CPT and ICD-9 codes.
Careless Diagnostic Coding
Relying much on pre-printed forms will result in careless diagnostic coding. Such coding practices will lead to denied claims with a long term effect. This will in turn reduce the relevant reimbursement.
Interpreting Abbreviations Incorrectly
There will be abbreviations used on paper or electronic encounter forms. If the coders go wrong in interpreting these usages, it will result in incorrect code selection. This happens mostly in the case of surgical procedures and medications.
Forgetting to Bill Administration and Medication Code Accordingly
In the case of immunization, injection or allergy shots, you are required to prepare bill for administration and medication according to the practice. If the vaccine for this purpose is provided by the state or brought by the patients themselves, then prepare the bill for only administration. Otherwise, the clinician should prepare the bill for medication as well as administration. If you don’t double check these claims, drastic mistakes will arise in coding.
Upcoding and Undercoding
Upcoding and undercoding are illegal practices. Upcoding refers to charging for services that were not performed at all, whereas undercoding occurs when all the services provided by the physician are not charged.
Unbundling refers to inappropriately coding the component parts of a procedure instead of reporting the procedure using a single available code. It may happen by mistake, but if it is intentionally done it would result in Medicare fraud. It is illegal and may prompt medical coding audits.
Measures to Avoid Medical Billing Coding Mistakes
- Refer to Updated Coding Books: Instead of relying much on software, update coding books yearly to cope up with the changes in coding practice. Even though utilizing the latest coding books may be expensive, it is more advisable than incurring revenue loss by using old coding books.
- Hire the Services of an Experienced Medical Billing and Coding Company: It is better to outsource billing and coding jobs to a reliable medical billing and coding company with wide expertise in this industry. Apart from the basic coding jobs, they can provide code checking services including emergency room e-code evaluation, and DRG/ICD-9-CM coding validations.
- Maintain Up-to-Date Knowledge about Insurance Companies: Insurance companies may change their norms according to their convenience. Coders should maintain constant contact with these companies and update their knowledge about applicable changes.
- Use Modern Technologies for Billing: Using new technologies will ease the job of medical billing and coding. Medical billing software is one of the most feasible technological solutions available today which can efficiently perform complicated tasks including scrubbing claims, predictive dialer usage and electronic remittance.