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8 Medical Coding Errors To Avoid

In the medical billing process, coding errors lead to claim denials, loss of revenue, and in the worst-case scenario, it is viewed as a fraudulent act that results in fines and imprisonment. nnIt’s crucial for every health service provider to avoid coding errors, which may disrupt their revenue cycle. The possibility of coding errors is very high, especially if some inexperienced coders are executing it. You can reduce the coding errors to some extent by observing some of the most common coding errors faced by the coders. nnFor your convenience, we broke down those coding errors below.n

1.  Unbundling:

nIn medical Coding unbundling is described as Using multiple codes for a single part of a medical procedure, when it can be covered by using a single code. This process can increase the amount which you claim to the insurer.n

2. Upcoding:

nIt refers to the coding error in which the patient has been charged for the services and treatment which is more expensive than the actual treatment and procedure actually performed. This activity is a clear violation of the False Claim Act and if someone did it intentionally then he can face some serious consequences. n

3. Improper Reporting:

nSometimes incorrect or missing information of patients like his name, address, and diagnosis can cause problems. It is one of the most common mistakes which was done by service providers. It not only includes misinformation about the patient but also the insurance company. This information is very essential for the coders to submit a successful claim to the insurance company, any interruption in these records can lead to denied claims. So, an accurate record is essential for proper coding.nn

4. Duplicate Billing:

nIt is the type of error in which a patient has been charged multiple times for services or treatment. It is one of the most common problems in the medical billing process. It might be the result of re-submitting the claim. This error can be reduced by checking the patient’s code and making sure of the accuracy and multiple coding.n

5. Under coding:

nIt is referred to a situation in which the patient is not charged fully for all the treatment or services he availed from the service provider. Under coding is usually considered as the opposite of upcoding. Usually, the service providers did under coding to avoid the audit. It is considered an illegal activity that results in loss of revenue and lower reimbursement rates.nnDespite the fact that most of the service providers do under coding to get rid of auditing. But in most cases, it occurs due to not knowing the exact coding. In any of those cases, it is still considered an illegal activity that should be avoided.n

6. Overusing Modifier 22:

n modifier 22 is used to indicate the increased procedural services, which is the measure of complexity and length of the services. There is a need for proper documentation because sometimes physicians added the services and treatment which is not required.n

7. Avoiding NCCI Edits:

n    NCCI refers to the national correct coding initiative. It helps the service provider to ensure the proper coding setup and avoid improper payments. It was introduced by the center for medicare and Medicaid services.nnThis is set up by NCCI edits which convert the bundling component codes into the inclusive code.nnAccording to American Medical Association” It is an automated prepayment edit that is reached by analyzing every pair of codes billed for the same patient on the date of the same services by the same provider to see if an edit exists in the NCCI” this system use CPT modifier to overcome the denial rate and the code will be denied if any NCCI edit exists. So, checking the NCCI edits helped you to avoid coding errors. n

8. Unlisted Codes Without Documentations:

nThese are the codes that are assigned to record the treatment and procedures of services that have no specified CPT code. There is a need for proper documentation for the effective use of unlisted codes.nnAlso Read 7 TIPS FOR REFINING YOUR MEDICAL CODING PRODUCTIVITY AND EFFICIENCYn

How You Can Avoid Coding Errors?

n These coding errors prove to be very dangerous and damaging if not addressed on the time it leads to the loss of revenue and in extreme cases a fine and imprisonment could be imposed for violating the FCA. There are a few things explained below which can help you to avoid coding errors.n

Proper Training:

n You can simply avoid the coding errors with the help of the proper training of your coding team, most of the coding errors occur due to negligence in coding. You can minimize those small errors with effective training of your staff members to avoid any future problems.n


nYou can also use the software which can help you to detect even minor errors in your coding. This process simply helps you in error-free coding which results in successful claim submission. n


nAs coding is a very complex procedure, errors and omissions are very common. It took lots of revenue and investment to train your team members to do proper coding Since it not only demands investment but is also a very time-consuming task.nnSo, it’s better to hand over these processes to a team of experts who can handle the coding operation appropriately and help you to save your time and money.nnMed-Miles has a team that is expert in providing coding services, we have an excellent record of submitting successful claims. We help many of our clients to eliminate the denial rates for a successful cash flow. Need more information? Call us at (888) 598-9181.

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