Loss in revenue, denial of claims, federal penalties, and exhausting audits- all these are consequences of coding errors.
These are as scary as they seem right now!
As healthcare services are expanding, so are pertinent medical codes. With newer codes and guidelines for usage coming in, coding errors are also increasing rapidly. These expanding codes, coupled with an even greater number of charts and fewer skilled coders is leading to a massive problem – errors in coding.
Here are the most common coding errors and a comprehensive list of solutions towards them:
Under coding and up coding
A key component of putting in wrong codes is either under-coding or up coding.
Under coding is when you report an expansive treatment or service at a lower level than it should be reported at. It can also happen when an entire procedure is excluded from reporting.
Over-coding or up coding is the opposite; or when you report more expansive procedures than what was actually performed.
Under coding and up coding signal poor medical coding and lead to revenue cuts and possible legal risks.
Not using specific codes
To get the correct reimbursement from the insurance provider, it is important to code to highest specificity for your diganosis.
For instance, some ICD-10 codes need a fourth or fifth character to get to the highest specificity.
Modifiers provide the additional information that the provider may need about the medical procedure, service, or supply involved without changing the meaning of the code. Some modifiers do effect the claim amount.
Using outdated references
With CPT, ICD-10, and HCPCS codes numbering in the thousands, it’s impossible to remember every reportable code and their guidelines.
Constant code updates make it hard to keep track of all the changes. Without appropriate resources, coders may not realize they are referring to incorrect or outdated codes, leading to code errors.
This causes inconsistencies in the entire medical billing cycle leading to grave consequences and rejection of claims.
These coding errors are not caused just by negligence. There can be series of events that lead to medical coding errors, including from using the wrong documentation. Here are the areas that you need to fix to avoid coding errors:
Use updated and detailed medical documentation
Coders use treatment details in the medical records to reflect the right code. Wrong or incomplete documents by the provider/physician leads to improper understanding and thereby inputting the wrong code. This ultimately leads to denial in claims.
To avoid errors due to inconsistent documentation, ensure physicians provide detailed information. Also, establish a communication channel for coders and physicians, so that any confusion can be clarified before codes are finalized.
Remain updated on medical codes
Most errors in medical codes arise due to inaccurate code assignment, sequencing, or incorrect use of modifiers. A common reason for all these errors is lack of knowledge of the codes. Coding guidelines change often; it is a good practice to remain updated on new codes every few months to avoid such errors.
Impart Medical Coding Education to your team
Knowledge of medical codes is not enough for accurate coding. Your coding team needs to have knowledge of disease processes, anatomy, and physiology so they provide the correct codes for medical conditions, diagnoses, and procedures. Since medicines and treatments continually change, ongoing education and training are vital to being successful.
Integrate AI-driven coding tools like Medicodio
A big reason for coding errors is increasing pressure on medical coders to process a high number of charts daily. Medical coding tools like AI release this pressure off the coding team by automatically reading charts and assigning codes, thereby reducing coding errors.
Medicodio is an AI-powered coding tool that reduces medical coding costs and improves efficiency by up to 45%. A great fit for RCM companies and hospital billing departments, Codio suggests medical codes (CPT, ICD10, HCPCS, modifiers) by reading patient demographic info from EHR systems and Physician Notes/Chart. After the medical coder makes a selection from the list of suggested codes, CODIO sends your codes to the billing system.