Reducing Common Coding Errors

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Few things are as detrimental to the financial success of a medical practice as coding errors. 

Coding errors lead to denied claims

Denied claims lead to:

  • Lost time correcting error
  • Potentially lost revenue
  • In some cases penalties and fines (rare, but still not fun to think about)

None of these outcomes are acceptable. To help guide your practice to the most desirable  outcome (being appropriately compensated in a timely manner) you should know the most common coding errors and what you can do to avoid them. 

Let’s start by looking at which errors are the most common.

  • Unbundling – This is when one code is available to capture multiple components of a procedure, but multiple codes are used instead.
  • Upcoding or Undercoding – Both of these involve using incorrect codes. Upcoding is when a healthcare provider submits codes for more severe and expensive diagnoses or procedures than the provider diagnosed or performed. Conversely, undercoding occurs when providers code a lower level of service than performed and/or documented (i.e., downcoding) or fail to code and report all the services provided. This results in the practice getting paid less than what they could have justifiably received from the insurance company. 
  • Duplicate Billing – This is pretty straightforward. This happens when a patient is billed multiple times for the same procedure or service. 
  • Overusing Modifier 22 – This modifier allows providers to be properly compensated “When the work required to provide a service is substantially greater than typically required.” It is important to remember that this code requires approval. 
  • Telemedicine Coding Errors – If your practice is offering more telehealth services, it is important to remember that those services require a different code. 

Now let’s look at how you can avoid these errors. 

  • Slow Down – The desire to get billing done in a quick and timely manner is
  • understandable. However if, in the process of getting the billing done quickly, mistakes are made, then you will cause yourself more problems in the long-term. The goal should be accuracy first, speed second when it comes to coding.
  • Training and Review – A way to get faster is to have a process that multiple people can follow. To this you will have to do training and take time to review when mistakes are being made. Take time to understand why denials happen and what can be done to prevent them from happening in the future. 
  • Assign Person To Be In Charge – While it may help to have multiple people lend a hand in your coding and billing process, it is beneficial to have someone you can trust to be a lead and oversee all the work that is being done. This person can help you understand what is working, what is not working, and how you may improve. 
  • Consider Outsourcing – Sometimes billing and coding can get too much for a practice. Especially if your practice is in a stage of growth. If you find that to be the case, consider outsourcing to a company that specializes in medical billing and coding.

It is unlikely that you will be able to prevent all coding errors. Only a billing and coding company with a proven record of high-quality work (**cough** Mednet **cough**), will be able to do that. However, by educating yourself and your staff on which errors to look out for and creating a system of planning and accountability, you can better ensure the most desirable outcomes when it comes to billing and coding.


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