Five Common Coding Errors in Medical Practices

Medical practices are concentrating on critical practice changes in 2013, but it is important not to lose focus on the basics of coding. Don't be guilty of these common errors:

1. Randomly using modifiers. Modifiers are two-digit codes added to a service that tell the payer of special circumstances. The AMA develops CPT modifiers, which are numeric, and CMS develops HCPCS modifiers, which are alphanumeric or alphabetic. Both types of modifiers can be used on CPT or HCPCS codes. Why would someone randomly apply a modifier? Misunderstanding, incorrect information, or a desire to get a claim paid. But for both compliance and revenue reasons, correct use of modifiers is critical. Using modifiers requires an understanding of the global surgical package and National Correct Coding Initiative (NCCI) edits. There are several good coding books on the market that exhaustively explain modifiers.

2. Selecting the wrong procedure code. With more than 75,000 CPT codes, it is easy to imagine selecting an incorrect procedure code. However, the source of this error is usually not confusion about the procedure performed. Incomplete or inaccurate code descriptions on encounter forms, cheat sheets, and electronic charge systems are a significant source of error. Failing to read the editorial comments at the start of the section in the CPT book or the notes near the code is another source for this type of error.

3. Failing to link diagnosis codes. A CPT or HCPCS code tells the payer what service was performed. The diagnosis code tells the payer the reason for the service. Some patients present for more than one condition and may require unrelated services. Other patients may receive a service that is only covered for a specific indication. For example, a patient presents to a family physician for hypertension, but has a wart destroyed at the same visit. The code for the office visit must be linked to hypertension, and the code for the wart destruction must be linked to the diagnosis code for warts.

4. Using a nurse visit in place of another service. Some practices still believe that they can charge a nurse visit with an injection or for a venipuncture "because our nurse takes the patient's vital signs." Or they ask, "Can we bill a nurse visit with a flu shot?" Nurse visits are bundled into injection codes, and will not be paid separately by a payer using NCCI edits, or any payer using proprietary edits. As for the venipuncture, the practice motivation is that a nurse visit pays more than a venipuncture. But, it does not accurately describe the reason for the visit or the service performed. If the reason for the visit and the service performed was venipuncture: bill venipuncture. If the patient presented for an allergy shot, bill for the administration of the allergen. Assessing the patient pre- and post-shot is part of the payment for the administration.

5. Not keeping up to date. Medical practices and hospitals are understandably cautious about budgets. But failing to keep up to date on new coding rules and initiatives is an expensive mistake. It results in lost revenue and potential compliance risk for practices.

If you can avoid only one error this year, avoid not keeping up to date on coding. By doing that, you will avoid many of the other errors mentioned in this article.

Betsy Nicoletti is the founder of Codapedia.com. She is the author of "A Field Guide to Physician Coding." She believes all physicians can improve their compliance and increase their revenue through better coding. She may be reached at betsy.nicoletti@gmail.com or 802 885 5641.