Medical Coding Mistakes that Affect Claims and Revenue

Medical coding entails extracting information from a patient encounter, and coding it for the purpose of medical billing and creating insurance claims. It is a crucial step in transforming services provided into billable revenue. Errors in medical coding can result in delays or even denials of claims, which impacts revenue. A pile-up of delayed reimbursements is both expensive and stressful, causing a backlog of paperwork and pressure on your staff.

Here are the most common mistakes that occur and recommendations to overcome them.

Unbundling Codes

A procedure for a patient likely has various components. When a single code can be used to capture payment for a procedure’s component parts, it should be used. Unbundling pertains to using multiple codes for the parts of a procedure. This can occur due to a misunderstanding, or in rare cases, may be an attempt at increasing payment. Clarifying codes is a simple check that avoids this issue.

Unlisted Codes

In some cases, an unlisted code may be necessary to properly bill for a service. This occurs when a service or procedure lacks a specific Current Procedural Terminology (CPT) code. When an unlisted code is used, reimbursement can be nuanced, so it is essential to properly document the code in order to minimize any delays.

Not Checking NCCI Edits

Coders must check National Correct Coding Initiative (NCCI) edits when they are reporting multiple codes for a particular procedure or service. These are automated prepayment edits that are generated by analyzing codes for a specific patient on the same day by the same provider. If there is an NCCI edit, then one of the codes is denied. Accurate coding is necessary to avoid this issue.

For instance, if services such as an excision and repair are performed at the same spot on the patient’s body on the same date, a single code is the right option. Multiple codes will result in an NCCI edit. However, if the repair and excision are performed at different sites on the patient’s body on the same date, a modifier is necessary to indicate the separate locations, and they can be billed separately.

Incorrect Details

This is a problem that can occur with new medical coders as well as veteran coders. While new coders are still familiarizing themselves with the work, veterans can fall prey to this issue as well. After working on codes thousands of times, experienced coders might work on autopilot mode based on a wealth of experience. This can lead to incorrect details. Even experienced coders must thoroughly read provider documentation and check codes as necessary. This ensures that they only code the procedures and services that are supported by the provider’s documentation.

Sometimes relevant details are left out, or the wrong code is selected. For example, a procedure may be coded as a routine procedure instead of a diagnostic procedure. Instituting a quality check with reviews to double-check work can remedy this issue. Regular evaluations of coders’ performance will motivate them to stay on their toes and code accurately.

Management Strategy

When mistakes in coding occur, they can quickly snowball, detracting from coding accuracy while necessitating re-work. Keeping an eye on opportunities for process improvements is imperative. A strong management strategy that continues to improve coding and educate the coding team will work wonders for your coding accuracy, and help you minimize any coding errors.

Are you ready to improve your coding accuracy and revenue cycle? With Allyhealth as your trusted ally in healthcare services, you can rest assured that your medical coding and revenue cycle tasks are in expert hands. Get in touch with us to find out more about our services.

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