Medical coders are used to describing performed procedures for medical claims, providing a standard that makes it much easier for claims to be processed. These codes can use ICD-10-CM, CPT, and HCPCS Level II classification systems as long as the approach your organization takes is unified.
Even with such a robust coding process in place, it can be all too easy for coding errors to be made. Whether the wrong code is used or it is omitted entirely, issues like this will usually be spotted, but this isn’t always the case.
Common Medical Coding Errors:
Non-specific diagnosis codes: Some coding standards are more detailed than others, and this can easily lead to insufficient coding being used for different procedures. The difference between ICD-10 and ICD-9 requirements is a good example of this, but this can be solved by collecting high-quality data about patients.
Incorrect modifiers: Using the wrong modifiers to submit a claim can easily result in lost reimbursement for medical companies. When modifiers are incorrect or missing, the patient’s insurance will be billed more or less than they actually owe.
While the issues above are very common, they aren’t the only coding errors that can impact your medical business. These include upcoding and undercoding, which can be intentional or accidental sources of error:
Upcoding: It can be very easy to accidentally add a more expensive procedure to a claim when the wrong code is used, and this is highly illegal when it is done on purpose.
Undercoding: Undercoding is the opposite of upcoding; cheaper codes are used for the procedures being performed. This won’t get you into trouble, but it can end up costing a fortune over time.
It is vital that medical and healthcare companies work hard to avoid coding errors. Not only can this lose your business money, but it can also damage your reputation with patients, suppliers, and referring bodies.