Five Biggest Medical
Coding Mistakes You Can
Avoid
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Oops! Thats 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
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frightening yet incredible world of
medical coding.
Mistake #1: Depending on
Memory
Okayso you have a great memory. Working for hours
in the field, you are bound to memorise codes for a
number of repeated procedures. But well 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.
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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.
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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 conditions 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, editors 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
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books, accompanying editors remarks, and the
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
patients visit, it is a gross error.
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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.
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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.
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take #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.
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ke #5: Ignoring Editorial Comments in Reference Book
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 books
maternity section! Simple!
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THANK YOU
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