From Errors to Emergencies: How Inaccurate Coding Can Affect Your Practice

Of all the stages of the medical billing process, medical coding is the most essential. It’s also, unfortunately, a point where many errors occur. 

Inaccurate coding can negatively affect your practice in many ways, ranging from simply wasting valuable time to loss of accreditation. The bottom line is that coding accuracy is critical to the success of any practice.  

Familiarizing yourself with the most common coding errors and how they can harm your clinic is a good start to avoiding them altogether. Once you know what they are, you can investigate whether they’re happening in your practice and determine ways to address them.  

This article will offer tips for improving coding accuracy, including steps you can take immediately for better performance. 

The Importance of Accurate Medical Coding

If you work on the clinical side of a medical practice, you may not be entirely familiar with how coding works. Medical coding is the process of representing medical information with alphanumeric codes as they relate to billing and reporting. 

These codes are then utilized by insurance and healthcare organizations to ensure that procedures, diagnostics, and equipment are deemed medically necessary, which is crucial to the reimbursement process. 

Epidemiologists and other specialists can also use medical codes to catch patterns in patient demographics that might signal a wide-scale health concern. 

There are a lot of myths and misconceptions about medical coding, though. Some of these may have negative consequences on your practice.

Myth No. 1: Coding Errors Are Solely the Responsibility of Medical Coders.

This is one of the worst misconceptions hurting clinics. Coding errors often start with appointment scheduling and continue through clinical healthcare services. It’s important to get coding correct from the beginning, or they may not be caught and corrected before a claim is submitted. 

Myth No. 2: Medical Billers and Medical Coders Are the Same Thing.

Medical billers and coders often get lumped together, but typically, they’re separate roles with different responsibilities. Medical coders assign codes to services and equipment. Once codes are assigned, medical billers send invoices and track down payments. 

Myth No. 3: Coding Audits Are Just an Unnecessary Hassle.

Performing routine coding audits is one of the best ways to uncover where coding errors originate in your practice. Armed with that knowledge, you can correct the errors and avoid many negative impacts discussed in the next section. 

Myth No. 4: There’s Nothing You Can Do About Faulty Coding. It’s a Fact of Life.

Too many medical practices simply shrug off coding errors as unavoidable, but that’s not true. They are fixable. By remedying coding faults, you reduce wasted work hours and simultaneously improve revenue reliability and patient satisfaction. 

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The Most Common Coding Errors and Their Impact on Practices

Understanding some of the coding mistakes most frequently seen today can reduce or eliminate many negative impacts. Let this list serve as a basis for the coding review for your practice. You may find the same issues may be causing problems for your clinic. 

Using Codes That Are Too General

Codes should be as specific as possible. For example, a cardiologist might order further testing or a procedure based on a patient’s previous history of heart disease. 

However, if the patient has hypertensive heart disease, that’s a more specific code. Even more specific would be using the code for hypertensive heart disease with or without heart failure or kidney disease.

Not Adding Code Modifiers

Code modifiers are extra digits that help make medical codes more specific. Not adding modifiers can affect reimbursement or lead to an incorrect diagnostic test for a patient, such as performing imaging on the wrong limb. 

Not Adhering to NCCI Edits

The National Correct Coding Initiative (NCCI) was developed by the Centers for Medicare & Medicaid Services in the 1990s. The NCCI edits are code pairs that cannot be submitted together. Usually, one code of the pair will not be paid, and sometimes even both. 

This coding error will cause claim denial and cost your practice time to correct. Patients may also be billed incorrectly, leading to unnecessary frustration with your practice.  

Failure To Correct Coding Errors Later

If a claim is returned unpaid due to a coding error, the mistake must be corrected. Some practices may simply resubmit the invoice as is, which won’t fix the original mistake. 

Submitting incorrect coding costs practices additional time in determining the error, correcting it, and resubmitting the claim, which also lengthens the revenue cycle.  

The consequences of coding errors have the potential to extend across all areas of a practice: 

• Failure to receive full revenue for services if invoices are denied 
• Reduced patient treatment options and/or poor patient outcomes 
• Patient dissatisfaction with practice due to billing conflicts 

• Fraud and abuse fines or even loss of accreditation 

Negative consequences that affect your practice’s bottom line are serious enough, but coding errors also influence morbidity and mortality outcomes. They must be taken with the utmost seriousness. 

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How Does a Practice Improve Coding Accuracy? 

Coding accuracy is the practice of making medical codes as precise and correct as possible. An accuracy level of 95% is considered the health industry standard, but is that inaccurate 5% okay to leave on the table? 

The uncorrected percentage of medical codes could cost your clinic time, aggravation, and revenue. It could also be diminishing proper care for your patients. 

Therefore, investing in ways to improve your coding accuracy is wise. Methods to address accuracy should include the following: 

• Set up a claims scrubbing process to review claims before submission and ensure correct medical codes. 
• Conduct regular audits on your coding processes to see where you need improvement or changes. 
• Train staff at all levels on the importance of accurate medical coding and which codes your practice uses most (more below). 
• Use coding automation tools to reduce human error, a major factor in medical coding errors. 
• Offer training and support to medical coders so they stay current with coding requirement changes and additions. 

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Top Takeaway Tips for Preventing Inaccurate Coding in Your Practice 

Hopefully, after reading the information above, you’ve committed to improving coding processes in your practice. Here are some tips you can use today to begin your journey to complete accuracy: 

Set Measurable Goals.

Be specific in your coding accuracy metrics. Don’t set vague goals like “Improve code accuracy.” Instead, use goals against which you can measure and document success.  

An example might be: “Go from 93% accuracy to 98% over the next quarter.” 

Provide Staff Training. 

Remember, coding accuracy starts with scheduling, the front desk, and check-in. Staff members who work in these areas should be trained on how to correctly enter initial services. Do you schedule appointments for complex procedures like endoscopies or angiograms? They should have the correct code descriptors assigned. 

Document Information Accurately. 

More than 40% of medical billing errors are tied to poor clinical documentation. Charting should include the correct information to back up medical codes in case of questions later. Encourage providers to be as detailed as possible in their notations and to stay current with charting responsibilities. 

Be as Detailed as Possible. 

Clinical staff perform initial patient assessments and should be working toward detailed medical record notes. It’s worth reviewing the most common codes with nurses and techs, especially if you work in a specialty or subspecialty. They are your first point of clinical contact, so they can watch for initial scheduling and diagnostics with an eye toward correct coding assignments in the near future. 

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