Medical coding is a process of applying
universal alphanumeric codes to the healthcare services like medical diagnosis,
procedures, and services and medical equipment used for a patient. A patient’s medical
records and documents like doctor’s notes, lab reports, and services lists are
used by the medical coders to ascribe the diagnosis and procedure codes.
Medical coders abstract the medical
information from the available documentation, assign the right diagnosis and
procedure codes and enable the process of friction-free claims submission.
Coding must be accurate, efficient, and secure to maintain healthy revenue and
compliance for the healthcare providers.
Coding Errors Affect Revenue Cycle Management
(RCM)
The coders must identify the diagnosis
and treatments received, and code them properly with ICD-10 code. These codes
show how much an entity is reimbursed for a specific treatment. Then the coders
must select the most accurate code for all the treatment specifications to
prevent the claims denials.
The medical coding error costs huge and
ends up in claims denials. It creates unwarranted compliance issues, which are
also more expensive.
Major coding errors:
1. Missing Details
The most common coding denial happens
when the wrong code was selected based on new or established patient
guidelines. This denial is an alarm to check the entire chart and not just the
header. Another reason for denial would be when a procedure is coded as ‘routine’
rather than as ‘diagnostic’. In these cases, missing the details of medical
records are the results.
2. Using Shortcuts
Though shortcuts seem helpful and get
you fast, they would take you to the dead end. Fixing the errors once done is
costly and more time-consuming than having it done correctly in the first
place. When a coder enters the codes for the charges without reviewing the
provider’s documentation/reports, there is a high probability for the codes to
go wrong or be missed.
3. Being Comfortable with Codes
Though being comfortable with codes, and
not having the necessity to check the codes seem expertise and experience in
medical coding, auto-pilot mode is another reason for coding errors. They
should read the reports and code to the highest level of accuracy than simply
relying on their memory.
Prevent the Errors:
1. Check Mismatch of Patient’s Information
Insignificant errors like errors in
patients’ names and gender can be a reason for claims rejection. The coders
should check the patients’ information thoroughly.
2. Double-checking Information
The coders should use the latest coding
books for reference to avoid errors. And always, double-check the information
coded that can cause claims denial. Correct procedure codes and diagnoses are
mandatory to reimburse the claims.
3. Highly Specific Codes
The coders are responsible for the
specificity of the codes, as ICD-10 codes required the last two digits to be
highly accurate to prevent claims denial. The coders should refer to the codebook
often when they are not sure about the codes for a specific diagnosis.
4. Using Latest Coding Manual Reference
Outdated reference affects the claims
process. The coders must update themselves with the latest coding manuals and
be relevant to the current coding standards. Using the latest coding manuals as
a reference saves time, energy, and friction.
Preventing errors in medical coding is
inevitable in the first place. Coding audits are also helpful yet being
accurate while coding can save a lot of time and money for the healthcare
providers. When selecting the medical coding services and medical coding companies, the providers should be careful enough to check whether the service
company can make the services better for you. As said earlier, errors in coding
affect RCM.
