The Most Common Medical Coding Mistakes That Can Lead To Claim Denials

As a medical coding and billing specialist, it is significantly important for you to minimize any coding and processing errors as you file claims. It is an important process and it has to accurate. The healthcare providers receive most of their revenue through the processing of successful claims. However, any coding mistake can lead to claim denials and delays from insurance companies. This could further cost you and your employer. Hence, it is important to take necessary measures to avoid any such mistakes.

Here are the top 10 medical coding mistakes that could cost you.

1. Using old coding books: The process of medical coding should always be carried out with updated guidelines and reference materials. Using old books for this purpose can lead to grave coding errors.

2. Ignoring editorial comments in the CPT book: Coders, billers, and physicians often asked a number of difficult questions regarding different types of medical services. Answers to these questions are usually available editorial comments in each section of the CPT book. Ignoring these comments may be led to coding mistakes.

3. Ignoring National Correct Coding Initiative: Most of the time, medical coders fail to check National Correct Coding Initiative edits when reporting multiple codes.

4.Improper injection code reporting: Coders should report only one code for a session relating injections. Report multiple units of code should be avoided.

5.Confusion between Modifier 51 and 59: Most of the time coders get confused between Modifier 51 and 59. Modifier 51 is used to report multiple procedures performed on the same day but can’t be used for “add-on” codes, whereas Modifier 59 is used to report distinct procedural service provided on the same day along with other procedures/services.

6.Cannot Link CPT and ICD-9 Codes: Medical coding can go wrong if the clinicians fail to link the CPT and ICD-9 codes.

7.Careless Diagnostic Coding: Careless diagnostic coding based on pre-printed forms will lead to denied claims with a long-term effect.

8. Interpreting abbreviations incorrectly: If the coders wrongly interpret the abbreviations used on paper or electronic encounter forms then it will result in incorrect code selection.

9.Reporting unlisted codes without proper documentation. Sometimes, proper billing requires the use of an unlisted code. It is then when the unlisted code should be sufficiently documented.

10.Unbundling codes: When coders use multiple CPT codes for different components of a procedure when a single code could be used instead.