5 Medical Coding Mistakes That Are Costing You Money
These common coding errors lead to denied claims, delayed payments, and potential compliance issues. Here's how to identify and fix them.
1
Upcoding
The Problem: Billing for a more expensive service than what was provided. This can trigger audits and fraud investigations.
The Fix: Always code based on documentation. If the documentation doesn't support a higher code, don't use it.
2
Unbundling
The Problem: Billing separately for procedures that should be billed together under one comprehensive code.
The Fix: Use CCI edits checker before submitting claims. Train coders on bundling rules.
3
Incorrect Modifier Use
The Problem: Using modifiers incorrectly or not using them when required. Modifier 25 and 59 are commonly misused.
The Fix: Create a modifier reference guide. Review LCD policies for modifier requirements.
4
Missing Diagnosis Codes
The Problem: Not linking the correct diagnosis code to justify the procedure, or using insufficient specificity.
The Fix: Code to the highest specificity. Ensure each procedure has a supporting diagnosis.
5
Duplicate Billing
The Problem: Accidentally billing for the same service twice or billing for services already included in a global period.
The Fix: Implement claim scrubbing software. Track global periods carefully.
Prevention is Key
- • Conduct regular coding audits (quarterly at minimum)
- • Invest in ongoing coder education
- • Use certified coders (CPC, CCS)
- • Implement claim scrubbing software
- • Stay current with coding updates
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