Medical Billing and Coding Blog interviewed a professional biller and coder with over 30 years of industry experience, and a current member of the National Advisory Board for the American Academy of Professional Coders. We got her take on the top 10 coding errors that she sees in medical billing and coding students. Here is her list of the top 10 coding mistakes:
1. Unbundling of codes
a. Unbundling is breaking apart codes that are inclusive of other codes. This not only affects reimbursement but it is illegal to do and will trigger an audit.
2. Not coding the diagnosis code to the highest level
a. This is due to the fact that some ICD-9-CM codes need a 4th or 5th digit to be accurate and correct, something that many beginning coders will miss.
3. Not understanding how to interpret the operative reports
a. For instance, if a laminectomy is performed, but the word laminectomy is not mentioned in the body of the operative report, the coder thinks that it has not been performed. The physician has described the procedure in the report but not mentioned the term laminectomy; fully understanding how to interpret the operative reports will limit this error
4. The physician not marking on the encounter form or superbill that they performed an x-ray gave an injection…etc
a. The coder has no idea that these were done unless it is mentioned in the documentation on the chart. Usually by this time, the coder or biller has already sent the claim out. They then have to submit an amended claim which could result in lost time and money.
5. Not having access to the provider, surgical tech or the documentation to be able to audit the claim.
a. In the situation where a coder is working off site from the provider’s office, they may not be able to contact the provider or see the documentation from the patient’s chart. If they have a question about something, they have no way of getting that information unless they have a good relationship with the physician’s office. Therefore, it takes a team of the physician, surgical tech, medical assistant, front desk staff and the medical records to sometimes get the information they need to code the claim correctly.
6. Coders and Billers not having access to the Explanation of Benefits.
a. The coders and billers have no idea of any mistakes that have been made when the claim has been denied. The bigger the practice the harder it is to track and correct these mistakes right away. Usually, whoever is putting in the payments work the denials. However, if the coder does not know what is wrong with the claim, they have no way of fixing the problem in the future.
7. Collecting the patient’s co-pay up front.
a. The co-pay should be collected before the patient sees the physician. The front desk coders should know in advance what the patient’s co-pay is and if they have met their deductible for the year so they can be ready to ask for it when the patient arrives. This is an agreement between the patient and the insurance company. If they continue to not pay their co-pay, the insurance company has a right to drop them.
a. This happens when the physician actually performs more than he charges for because he is afraid of an audit. This is just as bad as upcoding; charging for services that were not performed. This is also illegal and can trigger an audit as well by the OIG (Office of Inspector General).
9. Physicians not documenting everything they did in the chart even though they may have done it.
a. A physician’s note should be able to stand alone – what the patient is being seen for, the physical examination, the doctor’s assessment and his treatment plan. If it is not documented, it was never done and is not billable. Sometimes, this is where the coder needs to educate the physician on how to document.
10. Coder’s not keeping up with their education of what has changed from the previous year or even daily with some insurance companies.
a. Physicians need to realize that a coder’s job has to include continuing education. If the coders do not have the opportunity for continuing education, they will fall behind in their knowledge of the industry and therefore make mistakes.