6 Common Medical Coding Errors To Be Avoided
By Julius Raj Stephen
December 31st, 2015
Popularly referred to as the 'sunrise industry' medical coding is a booming outsourcing sector. And medical coders, are the torch bearers of this industry. But we need to stop and ask a question – are these torchbearers infallible? To err is human, and medical coders are not distant from this blatant truth. Here are the top 6 common errors made by medical coders and what can be done to avoid it.
- Wrong procedure-code – One of the most commonly sighted mistake is entering of wrong CPT code. Inaccurate code descriptions on encounter forms and electronic charge sheets is a grass root level error. Also, failing to read the editorial comments at the start of the section in the CPT book or the notes near the code is another source for this type of error. Many a times, a patient gets treated for more than one ailment but coders fail to notice multiple diagnoses.
- Using basic, memorised codes – Over a period of time, coders tend to memorize many codes while on job. Although this is a positive aspect, sometimes it can lead to coding errors. Memorizing stops the coders from reading the entire medical record. For instance, a patient may be treated for congestive heart failure. The medical code for this diagnosis is I50.9. But the actual diagnosis would be mentioned further below by the doctor in the documentation, indicating the patient to be suffering from systolic congestive heart failure. Hence, the accurate medical code would be different than the one assigned.
- Relying solely on software applications to identify codes – Under the pressure of meeting productivity levels and meeting deadlines, coders tend to rely heavily on software applications for codes. Though these applications are beneficial, if not checked and updated on a timely basis, can result in repeated errors on multiple documents.
Failing to link diagnosis codes – A CPT or HCPCS code tells the payer what service was performed. The diagnosis code tells the payer the reason for the service. Some patients may have more than one condition and may require unrelated services. For example, a patient may visit a family physician for hypertension, but has a wart destroyed at the same visit. The code for the office visit must be linked to hypertension, and the code for the wart destruction must be linked to the diagnosis code for warts. Failing to link the appropriate ICD codes with the relevant CPT codes will result in denials which in turn affects the payment.
Missing / inappropriate Modifiers: Modifiers are two-digit codes added to a service that tell the payer of special circumstances. Using modifiers requires an understanding of the global surgical package and National Correct Coding Initiative (NCCI) edits. Not appending the modifier or adding them to the incorrect CPT code will deny the claim and delay the payment.For example, if the patient visits a physician for E/M consultation, and if it is decided that the patient has to undergo a surgery immediately, "modifier 57 – Decision for surgery" needs to be appended with the E/M code to get it paid.If the modifier 57 is appended to the surgery code – it will get denied as "Invalid modifier". Coders should possess a thorough knowledge about modifiers and the relevant CPT codes.
- Missed Charges : The other major coding error is the missing charges. Busy practices can easily miss capturing charges for many of the services they provide. Lab and other ancillary services are the ones most often missed, simply because the order may be verbally communicated to clinical or lab personnel. Injections are another area where charge capture errors tend to occur. If the practice is administering injections and providing the injectable medications, two codes should be reported – one for the administration and one for the medication. The HCPCS codes for the medications include the name and the dosage for each unit of service. Missing to capture the services provided will result in revenue loss for the providers.