To err is human, wrote Alexander Pope. Of course, when it comes to medical billing, we all want as few “errs” as possible. It is important for all new coders and billers to be trained in your office setting and understand your protocols.
Let’s take a look at the top mistakes new coders make so you can avoid them:
- Incorrect EOB interpretation. Explanation of benefits (EOBs) from payers can be cryptic, and new coders may have a tough time understanding them.Emphasize this with new employees and encourage them to seek help from “old hands” for correct EOB interpretations. Test them on their understanding and how to handle denials before allowing them to work in this position with out supervision.
- Non-specific diagnosis codes. This is often the result of an inexperienced coder relying heavily on pre-printed encounter forms or lists of favorites. This is also a result of inadequate documentation to sport the dx code in the records. When this is an issue measures need to be taken to correct this problem to be ready for implementation of ICD-10, which is going to take it to a level that is more complex.
- Mismatched codes. Payers will deny claims based on CPT (current procedural terminology) codes if the diagnosis does not support the medical necessity of the service or is not a covered indication for that service. It’s important for diagnostic and treatment codes to match. This is where auditing claims before submission is vital.
- Ignoring editorial comments. The answers to many coding questions are hiding (in plain sight) in the editorial comments at the start of each section in the coding books. New coders, especially those using electronic coding systems, may not seek out these valuable paper-based resources. It is important to understand that coding and billing is changing rapidly and that you are aware of those changes, guidelines, and that the person training you is.
- Basing code selection on an abbreviated description. Incomplete or abbreviated descriptions often lead to incorrect code selection, and new coders may not feel comfortable seeking additional information from the provider. It is imperative that you find the comfort zone to do this. If not claims and dx will not be challenged and this will result in decreased revenue. This is not when you want to explain that you knew and did not feel comfortable to address your questions.
- Entering too few or too many digits for ICD-9-CM codes. Familiarity means experienced coders will usually realize they’ve entered the wrong amount of digits, not so with new coders. If you check your acknowledgement reports from clearinghouses, you will be able to see that claims were rejected in the front end for this reason. Many programs also have scrubbing features to catch this.
- Forgetting or abusing modifier 25. Modifier 25 indicates that a separate, significantly identifiable evaluation and management (E/M) service was performed on the same day as a procedure. It’s important to add the modifier to the E/M service, not the surgical procedure. Of course, simply adding modifier 25 to all E/M services is not acceptable. It is important for all billers and coders new and old to understand that because a modifier got it paid once, it is not always correct. Learn and know your modifiers as to when and why they are used.
- Incorrectly billing for injections. When the practice purchased the medication for a therapeutic injection, immunization, or allergy shot, bill for both the medication and the administration. If the state or the patient provided the medication, bill only for the administration.
- Confusing modifier 51 and 59. Modifier 51 indicates that the physician did two procedures on one day, and that the second is not a component of the first. Modifier 59 indicates that the physician performed a second procedure that is bundled into the first and meets the requirements of a separate, distinct service.
- Patient demographic data. This is one of the most common billing errors, so it stands to reason that new coders are often guilty of it. A payer will deny coverage if the patient’s age, date of birth, sex, or address are incorrect.
Knowing the pitfalls is the first step in avoiding these common “newbie” errors. Robust, ongoing training is, of course, the answer to lowering error rates across the board.
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