Another year, another listicle of medical coding errors. But then, like any other list, this medical coding errors list aims to bring to light things that needed to change in the industry, which in turn helps you to serve your clients better. Found below are some top medical coding errors that you should be focusing on eliminating this year:
Misused modifiers. Modifiers are two-digit codes—CPT (numeric) and HCPCS (alphanumeric)–developed by the American Medical Association (AMA) or the Centers for Medicare and Medicaid Services (CMS) respectively. According to an article penned by Janet Colwell titled How to Ensure Accurate Medical Coding, misusing coding modifiers is one of the most common coding errors there is to the coding and billing world. According to Colwell, an example of this modifier is Modifier 25 (CPT), which indicates that a physician has conducted a separate evaluation and management (E&M) service. At times modifier 25 is mistakenly used to bill for a “decision-making portion of the doctor’s visit” which rather be included in Medicare claims. Colwell’s lists other most commonly misused modifiers in her article utilizing examples from the National Correct Coding Initiative (NCCI) Policy Manual for Medicare Services.
Failing to link diagnosis codes. Betsy Nicoletti writes in her article Five Common Coding Errors in Medical Practices that it is essential for link diagnosis codes to the CPT or HCPCS codes. Diagnosis codes are codes that basically explain the reason a particular service or treatment has been requested for the patient, while the CPT or HCPCS codes indicate the type of service performed. As we all know, several services may be performed during a patient’s visit to address a single health condition or ailment. Mistakes during the coding process happen when the coder fails to ascribe the right diagnostic codes to a CPT or HCPCS code.
Missing or incorrect secondary diagnosis. “Secondary diagnoses may be missed by coders who code from a discharge summary alone without reviewing all documentation,” Ruth Orcutt says in her article, Common Coding Errors and How to Prevent Them. For the uninformed, secondary diagnoses are those coded when they do not satisfy the requirements of reporting secondary diagnoses. What basically happens is that secondary diagnoses errors are committed when the physician’s documentation has been overlooked.
DRG assignment errors. Aside from diagnoses, CPT or HCPCS coding errors, DRG (Diagnosis related group codes) assignment errors are also one of the most common assignment errors, according to Orcutt. The incidences of errors are quite severe, although it may or may not be the same as incidences in the U.S. In Estonia, a study conducted by the Kahur BMC Health Services Research revealed that up to 79 percent of cases have to be reassigned to another DRG in 2010. The study further revealed that 63 percent of the errors resulted from “incorrectly assigning cases” to a certain DRG group and led to overbilling. That was how bad coding errors relating to DRG assignments could be.
We understand how hard and focused coders work, especially when it comes to maintaining accuracy and delivering results. Human error, however, sometimes intervene with the quality of your work, but it’s alright. Know that by reviewing your work, undergoing a refresher medical billing and coding training and examining the errors you commit—which may be on this list or not—you will get to understand what you can do to prevent such mistakes from happening again and to improve on your work.