Question

Discuss some common causes of coding errors and the preventive measures you can use to avoid them.

Answer 1

These are the common medical coding errors and how to avoid them.

1. Misnterpretation of operative reports – Often coders do not bill for a particular procedure unless they see it specifically documented by the doctor.  Even if the description of the procedure is listed in the procedures performed, coders are hesitant to code it without the actual operative description.  This problem can be helped in two ways:  the provider can make sure to write down the specific operative description needed, and second, an experienced coder should be able to interpret an operative report properly and provide correct coding.
2. Lack of knowledge regarding bilateral procedure/services – Often the medical coder is at a second location, in an office away from the provider and the patients.  If the doctor forgets to write bilateral procedure or service such as injections, medications, X-rays, and so forth, the biller will have no way to code for them.  The provider must remember that he or she is a very important part of the coding process and that the bilaterals must be circled in the report to result in proper medical billing services.
3. Unbundling – This means separating into pieces a procedure and charging for each part separately when there is already a comprehensive code.  Besides being unethical, unbundling is illegal and it will attract an audit.  Have your coders know their comprehensive codes well.

4. Missing or Incorrect Information - Errors or omissions are a common cause of claim denials and can be easily prevented by double-checking all fields before submitting a claim. Incorrect or missing patient names, addresses, birth dates, insurance information, sex, dates of treatment and onset can all cause problems.Although it may not happen that often, sometimes information is accidentally entered in the wrong patient’s record. If billing employees only enter the information as provided and don’t investigate mismatches in treatments and diagnoses, a claim denial will follow. Unfortunately, in busy billing departments, these problems can be easily overlooked.

5. Code not to its highest specificity – Some ICD-9-CM codes need a fourth or fifth digit to get to their highest specificity.  If incomplete, the claim will be rejected.  If a coder is unsure whether a diagnosis is coded to its highest level of specificity he or she can look it up in the code book or on the internet.

6. Telemedicine Coding Errors -Healthcare technology makes providing quality care to patients in multiple locations much easier, but it also complicates the billing process.Incorrect use of modifiers for telehealth services results in payment delays. Synchronisation of telecommunication system could offer the solution to this.

7. Wrong codes used due to outdated reference material – The codes change and the staff needs to be up-to-date with those changes.  Sending coders to seminars or having them attend web-seminars, as well as running internal check-ups and purchasing sufficient supporting material for the staff, can prevent lost or delayed revenue that can be lost due to coding errors.  

8. Upcoding - Upcoding occurs when patients are billed for more complicated procedures than they actually received or bills are submitted for services that were never performed.Upcoding errors can occur if the billing department employee makes a mistake when entering diagnosis and treatment codes or if the employee is confused by the information provided by the physician.