Staying Mistake Free: 5 Keys to Halting Medical Code Errors
Medical coders assist physicians in submitting the proper codes and documentations to patients and other payers. The following are five common medical coding errors and suggestions on how to avoid them.
Wrong Interpretation of Operative Reports
Coders are only going to bill for procedures that they see documented by a physician. Even if in the report a doctor gives a description of the procedure, and even if the procedure is listed as being performed, most coders are not going to code it if there is not an operative description present. This problem can be solved by making sure that the provider writes down the operative description for every procedure performed, and the coder should be trained to be able to interpret an operative report and code it appropriately.
The Coder Does Not Know about the Bilateral Procedures/Services
In many cases, a medical coder is going to work in a different location than the physician and their patients. It’s easy for a doctor to forget to write down a bilateral procedure, like an injection, x-ray, or medications. If this happens, there is no way that a coder can bill for them. A physician must take responsibility for their part in the coding process. Bilaterals should be highlighted or circled to guarantee they are properly billed.
Unbundling
This is when an entire procedure is broken down into little parts and charged separately. If there is already a comprehensive code for the entire procedure, unbundling is unethical, illegal, and could lead to an audit. Coders must know comprehensive codes like the back of their hand.
Code Not to its Highest Specificity
Certain codes need four or five digits in order to reach their highest specificity. If the codes are not properly written, the claim may be rejected. This can be fixed by a coder guaranteeing that a diagnosis has been coded to the highest level of specificity. If they are not sure, they can use a code book or look it up on the Internet.
Using Outdated Material and Getting Wrong Codes
Medical billing codes change. For this reason, universities that provide an on campus or online health information degree teach their students the importance of staying up-to-date with the latest codes and the latest coding technology. Additionally, coders should go to seminars or attend web seminars to make sure they are up-to-date on codes.
Medical coding is an important part of the healthcare profession. When done properly, it guarantees that physicians are paid for the services they provide while at the same time guaranteeing that patients are only billed for the services they receive.
Case Management Training is key to understanding medical coding as well. Please review our Case Management Training program and let us know if you have any questions
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