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Top 5 Avoidable Coding Mistakes that Decrease Revenue

It’s no secret that insurance companies create an absolute labyrinth for physicians to collect the reimbursement they are due. Added complications, confusion, and opportunities for mistakes are present at every step of the way.

These 5 tips listed by Medical Economics are some of the most common coding mistakes that can be avoided. Whether you use a billing company or have in-house billing, physician owners should always keep in touch with the processes that keep them in business!

1. Inappropriate E/M Coding

Coding for evaluation/management services is often either too aggressive or too passive, and these coding errors are largely attributed to misinterpretation of E/M coding guidelines and the frantic pace of the clinical environment. Aggressive coding occurs when there isn’t proper documentation to prove out what was done. On the other hand, passive coding doesn’t take the entirety of the work performed into account.

2. Missing E/M Codes

Oftentimes, this is the result of incomplete charting, typically due to provider distraction. Charts without follow up typically result in the claim being sent late or unbilled.

3. Inaccurate Capturing of Patient Status

The confusion between whether a patient is new or established, which should usually be established at the front desk, can lead to lower payments if the patient’s status is not properly captured.

4. Missed Administrative Procedure Codes

Providers often miss administrative procedure codes for minor treatments, which can be a significant amount of lost revenue. This includes codes for injections, immunizations, immobilization, etc. Administering injections is among the most routine services provided in a primary care or urgent care practice, but one inoculation includes two codes: a CPT code for the injection, and a separate code for the medication or vaccination provided. Modifier 25 may also be applied if other care is being given. Another example of oversight can occur when placing a splint on a limb. There are two codes to enter: one for the application and another code for the supply item, such as a splint or a cast.

5. Inaccurate Utilization of Modifiers

The largest errors are the improper use of modifiers 25 and 59 to expand treatment, which can lead to audits and clawbacks. Modifier 25 should be appended to an E/M code to report a significant but separately identifiable additional service rendered during the encounter, such as an injection. Modifier 59 is used to identify procedures/services other than E/M services that are not normally reported together but were appropriate to render under the circumstances.

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