Top 4 Reasons for Errors in Medical Coding

According to a Healthcare Information and Management System report, it costs nearly $250 billion to process close to 30 billion transactions every year. Errors in these transactions can cost in terms of time and money for the health care provider. The most oft-repeated problems in these transactions arise due to medical coding errors.

Medical coding is the translation of a patient’s medical report into a short code for future reference. Accessing the code can present details about the patient’s condition, treatment taken, response to medication, and more. These codes are of prime importance for future diagnosis and treatment.

Let us look at four main reasons for errors in medical coding.

1. Not Coding Completely

All information regarding a patient’s health and treatment must be accurately translated to codes by the coders. It involves activities such as reading, note taking, assignment of codes, and computer entry. When coders fail to code to the highest level of specification it can lead to a rejected or denied insurance claim.

2. Not Using Updated Code Sets

Medical coding sets such as the AMA for CPT and the WHO for ICD release their updated manuals every year. In fact, some professional organizations require coders to complete a stipulated number of credits every two years, in order to stay updated. Failing to use updated code sets also come in the way of maintaining accurate medical coding records.

3. Inadequate Medical Information

This situation arises when the information provider does not provide adequate details about the procedure performed or treatment given to the patient. Additionally, for coders to perform their duties, the provider must be constantly in touch with them. Unfortunately, providers aren’t always available for coders when they have difficulty in understanding the claims. Illegible medical reports are also a cause for errors in medical coding.

4. Undercoding, Overcoding, and Unbundling

Undercoding and overcoding happen when medical reports state less or more expensive medical services than what was provided to the patient. Although they cannot be classified as errors, it can lead to unnecessary investigations and audits. Unbundling also does not fall completely under the error category, but should nevertheless be avoided. It is primarily false reporting by the provider in order to earn a higher payout. This causes coders to code information under different categories, when they would normally be included in one umbrella code.

Being diligent and keeping oneself updated about new code sets are ways to avoid medical coding errors. Coders also need to update themselves with revised guidelines, in order to stay up-to-date with coding practices. Problems due to medical coding errors can be largely brought down when communication between the coder and the provider is frequent, enabling coders to clarify their doubts immediately.

Navigating through the medical coding complexities can hinder your ability to provide sustainable service to your customers. Allyhealth can be the right partner to provide expertise in end-to-end medical coding support for your business. We also cater to a range of transactional and account receivables management services to make your growth in the medical practice smooth sailing.

If you’d like to know more about Allyhealth, get in touch with us.

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