Medical coding is a critical process that
requires accuracy in order to settle the insurance claims quickly. However,
errors may occur in coding that lead to higher or lower payments by insurer
which result in legal and financial implications for the health care provider.
We will figure out few errors that are common and should be avoided in medical coding jobs.
Under
coding: Due to the complex documentation
guidelines and procedures in E/M coding, health care providers often find it
difficult to select appropriate codes for the services. In order to avoid
claims being denied they often tend to do under coding. They feel safe to
undercode because they need not do considerable documentation which may be
difficult for them. However, with this practice of undercoding, health care
providers may lose huge amounts of reimbursement. Hence, medical coding services professionals should regularly keep on
updating themselves with coding guidelines and learn how to select an
appropriate level of E/M services.
Missing
charges: Many times it may happen that medical coders miss to code minor
procedures or code them incorrectly.
While using templates in the system, they may not find the code for a
procedure. These result in failure to capture charges for services provided and
denial of claims from insurers and thus bring revenue loss.
Missing
modifiers: Medical procedures are very complex by nature and require additional
information to code the patient’s visit accurately. The codes for this kind of
additional information can be found in modifiers of CPT and HCPCS codes. It is
often found that modifiers have an important role in reimbursements and if they
are not used appropriately, it may lead to loss of revenue. It is also found
that different payers have their own guidelines for the usage of modifiers.
Hence, for people in medical coding jobs,
it is critical to understand these guidelines to minimize revenue loss by
maximizing the reimbursements.
Unbundling:
This refers to the way a medical procedure is divided into separate parts and
coded when the whole procedure itself has a comprehensive code. This means that
a coding duplication of a procedure is happening which is both unethical and
illegal and will be traced in audits. This will result in legal implications.
Hence, professionals in medical codings ervices should be aware of individual codes and the comprehensive codes in
order to avoid unbundling.
Highest
level coding missed: Medical coders have to ensure that they code to the
highest level of specification. They have to see that they get the maximum
information from the providers and use it accurately while coding. For this
purpose, they ought to know the terminology for both medical procedures and
diagnoses and their relevant codes. If this is not taken care of and coding is
done at a general level, highest level coding is missed which results in claims
being rejected or denied.
Not using
updated codes: The coding manuals are generally updated every year. So, it is
the responsibility of the medical coders to update their knowledge regularly
and use the codes correctly and sharpen their skills on a continuous basis.
Stay sharp
and up-to-date in your codes, so that you don’t make errors in coding and get
ahead in the profession of Medical coding. The only way to become a top notch medical coder is to remain a
learner throughout your career. Keep learning all the new medical terminology
related to the diseases, illnesses, treatments and procedures and their
respective codes.
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