Medical coding has different facilities to code. Being a Medical coder, I always feel every coder has it own knowledge of choosing a right code. There are many scenarios where you will code differently while other medical coders will code it differently. This happens only in diagnosis coding. Since, we have many specific guidelines for coding correct ICD 10 code and also which one should be sequence first. But, one think should be always remembered that ICD 10 and CPT coding guidelines should be followed to improve our coding skills. Today, I am here just to share the most common errors done by medical coders in the ICD and CPT coding. These errors can be avoided if we just read and follow the coding guidelines.

Sequencing of ICD 10 codes

This is the most common mistake medical coders do. If you read the ICD 10 coding book, you should remember the list of codes which should be used as primary code and secondary code. Even the CPC (Certified Professional Coder) certified coders, are making errors in sequencing codes. Even, after carrying the CPC certification they are not aware of ICD 10 coding guidelines. For example, we have a list on Encounter Z codes, these codes are always required to be used as Primary Dx. Even in ICD 10 codebook, a symbol of Pdx is written next to these ICD 10 codes, which denotes that they should be always placed as Primary dx. For secondary diagnosis, it all depends on the diagnosis you are coding. If your diagnosis is related to your primary dx, it should always be reported. Unrelated diagnosis can be coded as incidental finding.

Missed to code Multiple ICD 10 codes

In diagnosis coding, we have few diseases like sepsis, diabetes with complication, hypertensive renal heart diseases etc. which requires multiple ICD 10 codes. To report, these ICD 10 codes, coders should know the coding guidelines perfectly. For example, for coding ESRD or End Stage Renal Disease on hemodialysis, coders only code the ESRD code N18.6, which need to be followed by the status hemodialysis ICD code as well Z99.2. The new status Z codes, V codes in ICD 9, are little tricky to be used by coders. I would suggest, if you not able to find the correct Z codes, just use the old V code and map with ICD 10, this way you can easily find the correct Z code. Also, in pregnancy the coders are missing the weeks of gestation codes Z3A series as secondary codes. You cannot afford to missed these codes now, since we have many specific ICD 10 codes available. These missing diagnosis mainly affects the reimbursement process in future.

Failed Medical Necessity

Medical Necessity should always fulfill the procedure code. Medicare denies the claims if you file the claim with a fail medical necessity. The coded ICD 10 codes should be related to the procedure performed. For example, if you code chest pain (R07.9) for the MRI head exam, if will be considered as unrelated diagnosis for the procedure done. For a chest pain, the physician cannot perform an MRI head exam. Hence, failed medical necessity should be taken care especially for Medicare Patients. Commercial payers might accept such codes, but this will be incorrect coding and can be called as “FRAUD” as well. Instead of X-ray if a physician is going for an MRI exam, just to raise the payment, he or she will fall into Fraud category. Hence, always code the ICD 10 code, which complement or related to the CPT code.

Errors while coding Mutiple CPT codes

CPT code are direct procedure codes. But, if you are coding multiple procedure codes, you need to code all the procedure codes. Medical coders tend to forget to read the notes below CPT codes. Most of the surgery procedure codes, comes with a coding note which requires the use of secondary code. For example, if you are coding a thyroid biopsy along with an ultrasound (76942) or Fluoroscopic guidance (77002), you need to report two CPT codes, one for biopsy and the other for the guidance. These multiple procedural coding is very important for coding surgery report. CPT codes carry a particular dollar amount, if you miss any single procedure code you will not be paid for that from the insurance company. For coding Outpatient procedures like X-ray, MRI, CT, Ultrasound Doppler exam etc. you will need mostly one procedure code, hence the error rate is also very low.

Modifiers Coding Errors

This is a very big topic to discuss. I know modifiers are little tough to understand in the beginning. But, they really affects the reimbursement. Yes, these two digits numbers are really dangerous than the five digit CPT codes. If you are coding for long time, than I hope you will easily code the 59 or X{EPSU} modifier with CPT codes. You can use the CCI edit tool for the use of this modifier. Use of 76 and 77 is also not tough in outpatient coding. Be careful with using modifier 25 and 27 in E/M coding. Use 26 and TC modifier carefully in Outpatient coding. For physician coding, it is mandatory to use 26 modifier along with CPT codes. In Short, do use these modifiers correctly.

Finally, errors will always help you to learn new things. But always remember do not repeat the same error or mistake again, this will decrease your accuracy in coding. Always try to improve as medical coder, which will surely help you to grow in medical coding career. All the best!!