Common Issues in Medical Coding

The job that eases the work of medical billers with detailed information of services provided and equipment used in the treatment of a patient to prepare accurate bills is medical coding. The work of a medical coder is to give appropriate universally accepted alpha-numeric codes to the procedures performed on a patient so that it facilitates the healthcare providers and other research organizations to classify and track illnesses, diseases, and mortality. The people in medical coding jobs have to ensure that they code to the highest levels of precision so as to help the billers in getting full reimbursements for the services provided by the healthcare facility. For this purpose, the medical coding professionals have to evaluate the medical transcription reports and use designated codes for the procedures. This job is not that easy and there are many issues that are part of medical coding jobs.

No access to the provider: Medical coders usually code based on the documents they have and also constantly contact the healthcare providers. However, in certain situations, it may not be possible for them to contact the providers which make their job challenging to understand the procedures and raise the claims.

Missing documentation or information: In some situations, it happens that the healthcare providers do not give the coders sufficient information they require about the procedures performed. The physicians may leave some information in the reports that leave the coders puzzled and lead to inappropriate codes.

Failure to use latest code set: The various code sets, ICD codes; CPT codes; HCPCS codes, that are used by the coders are updated annually and the onus is on the medical coding companies and medical coders to keep themselves updated with the latest codes that are brought out by the organizations that maintain these codes. In case, the medical coders fail to update with the latest codes, they may use wrong codes leading to billing issues and claim denials.

Errors that may be treated as a fraud: Some errors like unbundling, overcoding and undercoding can be treated as deceitful and coders should be cautious while assigning codes. Undercoding refers to the reporting of more expensive procedures as less expensive and overcoding refers to the reporting of less expensive procedures as more expensive. Unbundling is the coding of procedures in separate codes when they can be coded under a single code.

To avoid any kind of omissions and errors, the medical coding companies should ensure that their coders are diligent and alert. The medical coders should also communicate often with the healthcare providers to eliminate the chances of errors.

Common Issues in Medical Coding