“Oops! That’s my mistake”.
“No problem, everybody makes mistakes”. “But I am a medical coder”. “What?!!!
You are a criminal”!
Everybody makes mistakes. But
not a medical coder! Medical coders are counted as among the most meticulous
and careful professionals. Any mistakes they make directly impact the financial
revenue of hospitals and the processing of medical claims by insurance
companies. Despite their dedication to accuracy, stress associated with
deadlines and matters of productivity may sometimes leave them vulnerable to
making mistakes. Here are five biggest mistakes that you can avoid during your regular
tryst in the frightening yet incredible world of medical coding.
1.
Mistake
#1: Depending on Memory
Okay…so you have a great
memory. Working for hours in the field, you are bound to memorise codes for a
number of repeated procedures. But we’ll tell you – coding from memory is one
of the biggest blunders! Coders tend to memorise basic codes and no longer rely
on reference books, skimming medical records only superficially. Falling into
routine, they may simply over-rely on coding software, memory based coding and
cheat sheets. However, when coding from memory, you may run the risk of putting
in the wrong codes because all medical conditions, procedures, etc. vary from
case to case.
For instance, if you wrote
the direct code for CHF (congestive heart failure) several times, you are bound
to remember the code and use it every other time. However, if you read the
documentation carefully, it may actually say that a patient was diagnosed with
systolic CHF, which has a different code. Similarly, there are different codes
for hypertension and malignant hypertension. Simply recalling codes from memory
and keying them in is thus a hazard. Make sure you read the documentation
carefully and find out the correct codes from reference books rather than
merely using shortcuts.
2.
Mistake
#2: Incorrect Selection of Principal Diagnosis
Lack of enough knowledge of
coding terminology and principles, or lack of considerable experience may
result in incorrect selection of the principal diagnosis. Coders may tend to
code a complication as a condition, a definitive diagnosis as a symptom, or
assume a diagnosis without the condition’s definitive documentation. They may
also code only from the discharge summary rather than the entire documentation.
Such misinterpretation of coding guidelines may occur when coders do not read
the encoder messages, coding references, editor’s notes and inclusion and
exclusion terms carefully. To avoid this blunder, coders should stay up to date
on coding guidelines and should carefully read the reference books,
accompanying editor’s remarks, and the medical documentation of the patient
completely.
3.
Mistake
#3: Incorrect Use of Modifiers
The misuse of modifiers is
one of the most common coding mistakes, especially that of modifier 25. Modifier
25 indicates that a separate E&M (Evaluation and Management) service in
addition to a minor surgical procedure was performed by the physician for the
patient on the same day. If this modifier is simply used to code for the
decision making portion of the patient’s visit, it is a gross error.
For instance, when a
physician determines that a particular head trauma patient requires sutures,
and confirms his immunization and allergy status, obtains informed consent and
carries out the repair procedure, it is not considered as an E&M service and
modifier 25 is not to be used in this case. However, if the physician also
carries out a necessary full neurological examination, it may be reportable as
a separate E&M service. Many minor surgical procedures have a global 10 day
surgical period during which any follow up services for that procedure do not
qualify as separate services. For major surgeries, a 90-day global surgical
period applies.
Sometimes, coders also mix
up modifiers 51 and 59. Modifier 59 is used if the same surgical procedure is
carried out on multiple sites (for instance, removing lesions on various parts
of the body through separate incisions). On the other hand, modifier 51 is
required to report multiple procedures such as endoscopy and colonoscopy that
are performed together.
4.
Mistake
#4: Errors in Medical Code Unbundling
Medical codes are bundled
when they belong to a single billable procedure. For instance, a surgeon may
make an incision before a surgery. If it is an incidental incision, the surgeon
will be required to close the incision. A normal closure of the incision is
also incidental because the incision was made incidentally. Therefore, codes
for these need to be bundled as there is no need for separate billing. It is
thus important to know which procedures can be bundled and which cannot.
5.
Mistake
#5: Ignoring Editorial Comments in Reference Books
The editorial comments that
accompany various sections of a CPT book are extremely important as they have
answers to many troubling questions that a coder or biller may have. For
instance, if you are wondering whether you should report/bill for a preliminary
hospital service when admitting a pregnant woman in labour, you can simply find
the answer in the introductory editorial comments of the CPT book’s maternity
section! Simple!
Comments