Coding Errors in Medical Billing

According to the government and commercial insurance companies, most medical audits have shown fraudulent medical billing practices with results in coding errors in medical billing. Health practitioners should be paid for their medical services, but to stay out of trouble and keep their practice thriving, they must refrain from using unscrupulous billing techniques.

A study by the American Medical Association (AMA) and the Health Care Fraud Prevention and Enforcement Action Team (HEAT) shows that coding errors in medical billing remains the most common. The practice’s most common mistake is misreading the diagnosis, resulting in the wrong code being assigned to the patient’s visit.

If any coding errors in medical billing occur, more claims are denied, lost payments, and penalties will be applied to some extent. If any practice consistently makes coding errors in medical billing, it might undermine their relationship with patients. It’s not surprising and is very common that coding mistakes are made, given the numerous complexity levels of the medical coding system used in the healthcare sector.

Therefore, medical billing requires a high level of technical skill and attention to detail. Unfortunately, many practices need help with coding errors in medical billing and other problems that plague this process.

When a medical practice fails to code procedure/diagnosis properly, they will lose their reimbursements unless they correctly resubmit a claim after the payer rejects it with coding errors. One way to all coding needs is to outsource your coding process to an expert medical billing company to handle all of your coding needs and help you stay on top of the rules and regulations for coding.

Most Common Coding Errors in Medical Billing to Avoid

Many problems can arise in medical coding process. These problems are rare, but they can significantly hinder your coding procedures. Following are some of the most common coding errors to avoid:

Medical Procedures Not Being Coded to the Highest Level

Some common issues with medical coding include not coding procedures to the highest level of specificity, not correctly documenting medical conditions, and needing to record physician orders accurately. Coding procedures are complex, time consuming, and require a high level of expertise, so you need to be able to code medical procedures to the highest level.

However, the primary responsibility of the coder is to code as precisely as possible. This entails accurately noting everything and extracting the relevant information from the provider’s medical reports. It also involves understanding medical terms used to describe diagnoses and operations.

A claim may be rejected or denied if the coding is too generic or under-coded. If not adequately coded, these errors can result in no reimbursement, negatively impacting your practice’s financial stability.

Unbundling Medical Codes can Lead to Coding Errors in Medical Billing

Unbundling medical codes can lead to functionality problems and confusion in how codes are used. This can lead to confusion for patients and doctors and result in billing disputes.

A single code that captures payment for a procedure’s parts is recommended. Using several CPT codes for the various steps in a process is known as “unbundling,” which may be done unwittingly or to get paid more.

Missing or Wrong Medical Documentation for Coding

The coder may only sometimes receive enough details regarding the provider’s procedure. A medical report could be incomplete or written in unclear handwriting by the provider, leaving out crucial information about the procedure.

A medical document can miss essential information, such as the patient’s full name or medical history. This can lead to difficulties in coding the information correctly. Additionally, correct coding can lead to accurate billing.

Not Using Current or Updated Code sets

Medical coding guides are updated annually by the WHO for ICD, the AMA for CPT, and the CMS for HCPCS. Coders are responsible for learning and correctly utilizing new or rearranged codes as they are introduced.

For instance, ICD-9 codes were replaced with ICD-10 codes on October 1, 2015, and one of the essential advantages of ICD-10 is its capacity to give physicians accurate and comprehensive information. ICD-10 codes provide a more precise picture of the patient’s condition by indicating patterns, stages of care, particular diagnosis, and specific structure.

Over Coding and Under Coding

Common problems in medical coding include over- and under-coding. Over-coding occurs when a doctor writes too many detailed codes for medication or when a doctor enters too many codes for a medication than is necessary. Under-coding is the opposite. It occurs when a doctor doesn’t write enough codes to describe a medication or procedure.

In either case, an error has been made. If it happens once, it may be corrected. If it happens repeatedly, it can cost much money and result in a bad reputation for your practice. In our research, we found that the most common error was under-coding. This occurs when a doctor does not put enough codes on a bill to accurately describe what they have done, ultimately putting its name into common coding errors in medical billing.

Excessive Use of the Additional Procedural Services under Modifier 22

The modifier 22 procedural services are used too frequently on medical bills. This modifier is used to indicate that a patient received more than the average number of procedures or services.

This modifier can be used on any medical bill but is most commonly used on bills for hospital care and does not ensure further compensation. To get approval on this, proper paperwork is required. If you are still determining if you have used the correct modifier, check with your billing specialist to ensure you are using it correctly to avoid any coding errors in medical billing under modifier 22.


Outsourcing Your Practice Coding Procedures to a Billing Company to Avoid Coding Errors in Medical Billing

Outsourcing your practice coding procedures to Pyramids Global can save you time and money. Even the most seasoned professionals will need help to keep up with the work involved in medical coding. A few minor mistakes could have a significant impact. Because of this, it makes sense to outsource your coding procedures so that you may focus on your patient care coordination and reduce any coding errors in medical billing.

By hiring a medical billing expert, you can rest assured that your coding procedures are accurate and up to date and that you receive the accepted reimbursement for your services. However, you will have the following benefits if you outsource your medical coding to us:

  • Certified medical coders to do the coding for your practice adhering to the medical coding laws and regulations.
  • All of your claims will be thoroughly reviewed before submission.
  • A swift process for getting claims out to payers will significantly reduce the time for payment.
  • The correct E&M levels ensure accurate reimbursement for the services rendered.
  • Codes that are up to date for CPT, ICD10, and HCPCS will be assigned and NCCI edits to minimize the error rate and ensure a less stressful audit process.
  • Complete support for your revenue cycle management with the highest coding accuracy and compliance standards.
  • Error-free claim submission and streamlined workflow allow you to avoid costly errors and potential lawsuits.
  • It will be easier for you to focus on your primary duties rather than indulging yourself in coding procedures.
  • It can lead you towards lower expenses which can be very helpful when trying to keep up with the demands of running a busy practice.
  • Outsourcing your practice coding procedures to a billing company will improve patient satisfaction and better financial results for your practice. This will lead to more satisfied patients willing to revisit your practice for future treatment needs.
  • By outsourcing your practice coding procedures, you can ensure that your providers follow the same guidelines and adhere to coding compliance rules.


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Final Thoughts

Medical coding can be a very challenging area of the medical billing process. To run a successful practice, you must ensure that you are well-versed in all medical coding rules and regulations. You need to understand the intricacies of medical coding so that you can code claims accurately and avoid any mistakes that may result in a loss of revenue.

You must also be familiar with the latest coding changes and improvements to stay up-to-date. You should never overlook the importance of medical coding, as it is essential to your practice’s success and overall financial stability.

So, outsourcing to a billing company is the best way to go if you want to improve your medical coding and billing processes. We are coding experts and know what your expectations are. We will help you save time and money and eliminate the hassle of ensuring that your coding is correct. We will significantly increase your revenue by lowering coding errors in medical billing and speeding up the workflow process.



Q1. What are the most frequent coding errors in medical billing while reporting claims?

Ans: Following are the frequent mistakes made while reporting medical claims:

  • Insufficient data.
  • The failure to supply payers with supporting information for claims leads to rejections or delays.
  • Upcoding and errors in primary healthcare coding.
  • Incomplete or incorrect information
  • Incorrect procedure codes or lack of appropriate modifiers.

Q2. How can you prevent coding errors in medical billing?

Ans: You can prevent coding mistakes while billing with the following steps:

  • Ensure that patient information is accurate and aligned with data and do not up code and apply NCCI edits.
  • Employ the most recent medical coding manual and avoid billing duplication.
  • Verify insurance coverage and benefits beforehand, and try to employ a qualified medical biller.

Q3. What are the consequences of inaccurate medical billing coding?

Ans: Inaccurate medical billing coding will result in the following:

  • Reimbursement delays.
  • Denials or partial payment.
  • Build up a stockpile of delayed payments, which could make your medical practice overwhelmed with paperwork, stress, and lost earnings.

Q4. What harm might come from using incorrect codes while treating a patient?

Ans: The wrong action can be taken if codes are misread because a patient’s health is at stake if incorrect diagnoses are submitted. One misstep in the adjustment might shift the focus of the operation to a different area. Extra CPT codes may add up to an extra bill for the patient.

Q5. What use do CPT codes serve?

Ans: The Current Procedural Terminology (CPT) codes provide physicians and healthcare providers with a standardized language for recording medical services and procedures to expedite reporting, improve accuracy, and increase productivity.

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