Five Biggest Medical Coding Mistakes You Can Avoid

“Oops! That’s my mistake”. “No problem, everybody makes mistakes”. “But I am a medical coder”. “What?!!! You are a criminal”!

Everybody makes mistakes. But not a medical coder! Medical coders are counted as among the most meticulous and careful professionals. Any mistakes they make directly impact the financial revenue of hospitals and the processing of medical claims by insurance companies. Despite their dedication to accuracy, stress associated with deadlines and matters of productivity may sometimes leave them vulnerable to making mistakes. Here are five biggest mistakes that you can avoid during your regular tryst in the frightening yet incredible world of medical coding.

Mistake #1: Depending on Memory

Okay…so you have a great memory. Working for hours in the field, you are bound to memorise codes for a number of repeated procedures. But we’ll tell you – coding from memory is one of the biggest blunders! Coders tend to memorise basic codes and no longer rely on reference books, skimming medical records only superficially. Falling into routine, they may simply over-rely on coding software, memory based coding and cheat sheets. However, when coding from memory, you may run the risk of putting in the wrong codes because all medical conditions, procedures, etc. vary from case to case.

For instance, if you wrote the direct code for CHF (congestive heart failure) several times, you are bound to remember the code and use it every other time. However, if you read the documentation carefully, it may actually say that a patient was diagnosed with systolic CHF, which has a different code. Similarly, there are different codes for hypertension and malignant hypertension. Simply recalling codes from memory and keying them in is thus a hazard. Make sure you read the documentation carefully and find out the correct codes from reference books rather than merely using shortcuts.

Mistake #2: Incorrect Selection of Principal Diagnosis

Lack of enough knowledge of coding terminology and principles, or lack of considerable experience may result in incorrect selection of the principal diagnosis. Coders may tend to code
a complication as a condition, a definitive diagnosis as a symptom, or assume a diagnosis without the condition’s definitive documentation. They may also code only from the discharge summary rather than the entire documentation. Such misinterpretation of coding guidelines may occur when coders do not read the encoder messages, coding references, editor’s notes and inclusion and exclusion terms carefully. To avoid this blunder, coders should stay up to date on coding guidelines and should carefully read the reference books, accompanying editor’s remarks, and the medical documentation of the patient completely.

Mistake #3: Incorrect Use of Modifiers

The misuse of modifiers is one of the most common coding mistakes, especially that of modifier 25. Modifier 25 indicates that a separate E&M (Evaluation and Management) service in addition to a minor surgical procedure was performed by the physician for the patient on the same day. If this modifier is simply used to code for the decision making portion of the patient’s visit, it is a gross error.

For instance, when a physician determines that a particular head trauma patient requires sutures, and confirms his immunization and allergy status, obtains informed consent and carries out the repair procedure, it is not considered as an E&M service and modifier 25 is not to be used in this case. However, if the physician also carries out a necessary full neurological examination, it may be reportable as a separate E&M service. Many minor surgical procedures have a global 10 day surgical period during which any follow up services for that procedure do not qualify as separate services. For major surgeries, a 90-day global surgical period applies.

Sometimes, coders also mix up modifiers 51 and 59. Modifier 59 is used if the same surgical procedure is carried out on multiple sites (for instance, removing lesions on various parts of the body through separate incisions). On the other hand, modifier 51 is required to report multiple procedures such as endoscopy and colonoscopy that are performed together.  

Mistake #4: Errors in Medical Code Unbundling

Medical codes are bundled when they belong to a single billable procedure. For instance, a surgeon may make an incision before a surgery. If it is an incidental incision, the surgeon will be required to close the incision. A normal closure of the incision is also incidental because the incision was made incidentally. Therefore, codes for these need to be bundled as there is no need for separate billing. It is thus important to know which procedures can be bundled and which cannot.

Mistake #5: Ignoring Editorial Comments in Reference Books

The editorial comments that accompany various sections of a CPT book are extremely important as they have answers to many troubling questions that a coder or biller may have. For instance, if you are wondering whether you should report/bill for a preliminary hospital service when admitting a pregnant woman in labour, you can simply find the answer in the introductory editorial comments of the CPT book’s maternity section! Simple!

Five Biggest Medical Coding Mistakes You Can Avoid