It’s not always possible to talk frequently with your provider (especially if you’re working for an off-site coding agency). Read over every medical report twice (at least), and never let yourself get “too familiar” with a particular code set or set of procedure codes. You can avoid a lot of medical coding errors just by double-checking your work. Your work as a medical coder will be detail-oriented and full of tiny choices to make every day. How to Avoid Medical Coding Errors Be Diligent Unbundling means separately coding procedures that would normally be included in one umbrella code. Unbundling is closely related to upcoding, in that it involves false reporting designed to earn the provider a higher payout from a payer. Like under- and overcoding, unbundling is not so much of an error as it is a fraudulent practice. These aren’t errors, per se, but we’re obligated to mention them here as something you absolutely must avoid. Both of these are fraudulent, and can lead to audits and investigations. Undercoding is the purposeful reportage of less expensive medical services than were performed, while overcoding is the reportage of more expensive procedures than were performed. We mentioned these in Course 3-7, but they’re worth mentioning again. This is partly why professional organizations like the AAPC and AHIMA require every member to complete a certain amount of educational credits every two years. It’s up to coders to learn any new or reorganized codes as they come out, and use them correctly. The organizations that maintain the three principal medical coding code sets (the WHO for ICD, the AMA for CPT, and the CMS for HCPCS) update these manuals yearly. Coders have to do the best with what they have in these situations, but you should still try and clarify the report as best as you can. Providers aren’t always available to consult on difficult-to-understand claims. Unfortunately, that’s not always the case. Ideally, every coder would be in constant contact with the provider they’re coding for. This problem is exacerbated by the next trouble spot on the list. Providers may leave important details of the procedure out of the report, or they may provide illegible medical reports. In certain cases, the provider won’t give the coder enough information about the procedure they’ve performed. Of course, not coding to the highest level isn’t always the coder’s fault. Coding to a general level, or undercoding (which we’ll discuss in a moment) can lead to a rejected or denied claim. It also means knowing the medical terminology for both procedures and diagnoses. This means abstracting the most information out of the medical reports from the provider and taking accurate notes. Common Issues Not Coding the Highest LevelĪs we’ve mentioned in the previous courses, the coder’s job is to code to the highest level of specificity.
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