DRG Coding Advisor
Five common types of coding mistakes
Expert outlines what to watch for
"Typically, it is newer coders who account for the majority of all coding errors, and usually these mistakes are concentrated in a few specific areas," observes Hank Vanderbeek of IRP Inc. (www.IRP.com), a medical coding and reimbursement consulting firm in Billerica, MA. To reduce mistakes among newer coders, Vanderbeek recommends practices watch for these five common mistakes:
1. Confusing principal diagnosis (PDX) with admitting diagnosis (ADX). Is the condition established "after study" to be chiefly responsible for causing the admission of the patient to the hospital? "This can be the ADX but it is not always so. The PDX is usually found after work-up or even surgery," he notes.
2. Coding past conditions that have no effect on the patient’s current stay. Vanderbeek says coders should only report codes for diagnoses that require one or more of the following: clinical evaluation; therapeutic treatment; further evaluation by diagnostic studies, procedures, or consultation; extended length of hospital stay; or increased nursing care and/or monitoring. Here’s an example: A patient is admitted with a hip fracture. The medical record also mentions a hiatal hernia, which receives no attention or treatment. Recommendation: Do not code the hernia.
3. Coding symptoms that are an integral part of the disease process. When a patient is admitted with nausea and vomiting due to gastroenteritis, only the gastroenteritis is coded because nausea and vomiting are symptoms, he says.
4. Not coding from both the alphabetical index and the tabular list. To avoid inadvertent mistakes, first look to the index of the coding manual for the condition or procedures to be coded, then verify the code listed there in the tabular list.
5. Mistaking "not elsewhere classified" (NEC) with "not otherwise specified" (NOS). "NEC is used when the medical condition specifies a condition but no separate code is listed in the alpha index or tabular list," says Vanderbeek. In turn, NOS is used when the information provided does not warrant either a more specific or "other" code assignment.
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