While some medical coding errors are a result of intentional misrepresentation, others may stem from an innocent mistake, according to the American Medical Association.
Either way, the consequences are costly. Here are five common medical coding mistakes to avoid:
1. Unbundling codes. Unbundling means using multiple CPT codes for different components of a procedure when a single code could be used instead to capture all the components. Single catch-all codes should be used when available.
2. Upcoding. Upcoding occurs when a provider meets with a patient briefly, but a coder bills for a full exam lasting 45 minutes. In one instance, a psychiatrist was fined $400,000 for upcoding.
3. Neglecting to check National Correct Coding Initiative edits. When reporting multiple codes, coders should consult the NCCI, which are automated prepayment edits. The NCCI analyzes every pair of codes to see if an edit exists. If there is an NCCI edit, it means a code is denied.
4. Improper injection code reporting. Coders should only report one code for a session involving injections. Do not report multiple units of a code.
5. Reporting unlisted codes without proper documentation. If proper billing requires the use of an unlisted code, it's crucial that the unlisted code is sufficiently documented.
Read about more common coding mistakes on the AMA's website.