Physician's Coding Strategist:
Here’s how to avoid the top 10 coding mistakes
The Top 10 coding goofs, according to Ruthann Russo, executive director of HP3 Healthcare Concepts, a reimbursement and coding consulting firm in Bethlehem, PA, are:
- Failure to document services billed
- Failure to provide signatures
- Consistent assignment to the same level of service
- Billing as a consult rather than an office visit
- Use of invalid codes (e.g., codes taken from an outdated resource)
- Unbundling of procedure codes
- Misinterpreted abbreviations
- Failure to list chief complaint
- Billing as a separate professional fee those services included in a global fee
- Use of an inappropriate modifier or no modifier for accurate payment of a claim
Besides setting off compliance bells with federal auditors, miscoding can also cost you money. Even small mistakes can add up to big bucks. At one 200-physician multispecialty group, Russo’s firm found improper coding practices of evaluation and management-level assignments resulting in an estimated $10 million in unbilled services. And that is "a figure that we felt was conservative," she notes.
Nearly nine of 10 coding errors result from mistakes in processing claim forms, says Russo.
A doctor working in the emergency department may fail to write down the chief complaint, thinking the coding staff will use documentation from the registration form. However, this won’t happen, because the coding can only be based on physician documentation.
When it comes to reducing physician-related coding errors, "the most important thing you can do is educate physicians on what is important, what they must do to correctly code and to make sure that their coders get their certified professional coder designation," advises Jim Gibson, vice president of Comforce, an Addison, TX, health care staffing and recruiting company.
To help reduce the incidence of coding mistakes, the 23-physician Texas Gulf Coast Medical Group in Houston holds regular coding workshops for its physicians and billing staff, notes Susan R. Waldron, the group’s executive director.
This practice also conducts periodic revenue team meetings in which a physician, a nurse, a front desk representative, a scheduling department representative, and a business office supervisor discuss current claims documentation and billing issues.
One surprising fact these meetings have uncovered is that the group’s doctors tend to undercode rather than overcode, contrary what recent government reports might lead many to believe.
One reason for this is that many physicians are unsure of exactly what the latest rules are and are afraid of having the coding cops sweep down if they overcode. Most physicians prefer to take the conservative approach and undercode, according to many coding consultants.
An easy way to address your practice’s coding problems is to perform an internal audit to determine the most common reasons that claims are denied or sent back for additional documentation. From this audit’s results, you can create a priority list of in-house coding and documentation practices that need to be examined more closely.
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