Prevent Top Medical Coding Mistakes in 2018

1

• Prevent Top Medical Coding Mistakes in 2018

2
Prevent Top Medical Coding Mistakes in 2018
Medical coders and billers are critical to the
healthcare business. By carefully recording
patient treatments and procedures they keep
doctors and nurses organized and on track. Also
they submit bills to insurance agencies, which
then pay claims. If biller or coder makes a
mistake, it can delay the claims process, cause a
loss of revenue and/or potentially affect a
patients care. Recent audits by Government and
private insurers have exposed many unfortunate
cases of abusive or fraudulent medical billing
practices. While you deserve to be paid for the
medical care you provide, but it is equally
important that you avoid improper billing
practices to stay away from trouble and continue
a booming practice. Medical Coding errors fall
into two wide categories Fraud Abuse.
Fraud is deliberate misrepresentation. Whereas
abuse means the falsification was an innocent
mistake, but nonetheless representative,
according to the AMAs Principles of CPT Coding,
ninth edition. Either way, the consequences are
costly. An example of abuse could include coding
for a more complex service than was performed due
to a misinterpretation of the coding
system. Here are some of the most common
mistakes to avoid in medical coding that can
result in claim denials, costing your practice
big time.
Medical Billing Services in Oregon
3
Prevent Top Medical Coding Mistakes in 2018
Unbundling codes With huge number of CPT codes,
it is extremely easy to unintentionally select
the incorrect procedure code when completing
claims. Unbundling means using multiple CPT codes
for different constituents of a procedure when a
single code can be used instead to capture all
the constituents. It involves charging procedures
individually so that the provider gets a greater
payout. It is considered intentional and
fraudulent. Single catch-all codes should be used
when available. Upcoding Upcoding happens when a
provider meets with a patient for a few minutes,
however a coder bills for a full exam lasting 45
minutes. The consequences for upcoding can be
severe. In one instance an psychiatrist was fined
400,000 for upcoding. He used to charge for 30
or 60 minutes sessions with patients even if in
reality he was only meeting them for 10-15
minutes for checking medications. Neglecting to
check National Correct Coding Initiative (NCCI)
edits when reporting multiple codes. The Centers
for Medicare Medicaid Services developed the
NCCI to make sure that accurate coding methods
were followed and avoid inappropriate payments
for Medicare Part B claims. The NCCI analyzes
every pair of codes to see if an edit exists. If
there is an NCCI edit, it means a code is denied.
Medical Billing Services in Oregon
4
Prevent Top Medical Coding Mistakes in 2018
Neglecting to add the suitable modifiers, or
appending wrong modifiers Care should be taken to
add correct and suitable modifiers. Overusing
modifier 22increased procedural services It is
very important to include appropriate
documentation explaining why the procedure
requires more work than usual. Reporting
unlisted codes without documentation If proper
billing necessitates the use of an unlisted code,
its imperative that the unlisted code is
adequately documented Reporting Injection Codes
Inaccurately Coders should only report one code
for a entire session including injections. Do not
report several units of a code. Outsourcing your
medical coding services to a medical coding
company can help your practice avoid these top
coding errors. It enhances your reimbursement
and reduces your practice compliance risk
Medical Billing Services in Oregon