The medical coders in the healthcare organization should be diligent and detail oriented. The objective of any medical biller is to validate that every provider is correctly reimbursed for their services. Although, at times even the rock star coders sometimes make mistakes that can cause claim denial rates to escalate and put revenue at risk.
The medical coding errors mainly fall into two categories “fraud” and “abuse”. 5 of the most common medical coding errors identified by the American Medical Association are mentioned below:
1. Unbundling codes
Unbundling refers to using multiple CPT codes for those parts of the procedure that are covered by a single comprehensive CPT code, either due to misunderstanding or in an effort to deliberately increase the payment.
2. Upcoding
It is a fraudulent medical billing in which a bill sent for a higher-level service or procedure or a more complex diagnosis that is supported by medical necessity, medical facts, or the service that was provided.
3. Failing to check the National Correct Coding Initiative (NCCI) edits when reporting multiple codes
NCCI was developed to ensure that the correct coding methods were followed and avoid incorrect payments for Medicare Part B claims. It is essential to check these edits when reporting multiple codes.
4. Improper reporting of the infusion and hydration codes
For medical coders to accurately bill for these services, precise documentation of the start and stop times are vital. Example: A continuous intravenous hydration is given from 11 p.m. to 2 a.m. In that case, instead of continuous infusion, the two administrations should be reported separately as an initial (96374) and sequential (96376).
5. Improper reporting of injection codes
It is ideal to report only one code instead of multiple units of code for the entire session during which the injections were given.
Knowing the pitfalls is the first step in avoiding these common “newbie” errors. The key for coders is to meticulously review all provider documentation prior to selecting the appropriate codes. Furthermore, coding leaders should constantly review processes and workflow strategy to ensure the running of a high-quality coding department.
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