Top Common CPT code Errors by Medical Coders

Procedures codes are very important in Medical coding. The process of payment mostly depends on CPT codes. Each CPT code refers a procedure, which has a particular dollar value. Medical coders need to use one or multiple procedure codes to define a procedure. But, even a single unit of change in  CPT code will completely change the definition of that procedure. 

I have been using CPT codes from last 8 years and have come done lot of errors while using them. Till you don’t do errors you will not learn, this happens with everyone. But, it will be better if you learn form other mistakes, so that you don’t do those errors. Hence, today I would share the common mistakes I have done while using procedure codes, which might help you to improve your coding skills in medical coding.

Modifiers confusion with CPT codes

Modifiers is a very big topic. The number of modifiers are less but they are very tricky to use with CPT code. In the beginning, I was into radiology facility. During this period, I have always in double mind whether to use 26 modifier or TC modifier. Even, today I am not sure to which modifier should be used with radiology CPT code.

Later when I was improved a little in coding diagnostic radiology, I was shifted to coding surgery charts.Now, in surgery again modifiers was a big headache for me. I learnt the use of modifier 58, 78, 79, 57 etc in this facility. I was confident with CPT codes in surgery, but when it comes to modifier my confidence used to come down. I will always tell the new fresh coders, if you become confident with using modifiers then you can easily code any facility and even you can clear the medical coding certification exam like CPC in future.

Later after few years, I was shifted to code E/M facility charts. Now, here again I learnt the use of modifier 24 and 25 with E/M codes, which was very interesting. Since, these two modifiers has a very little difference between them, it was not difficult for me to learn them.

Use of Wrong Imaging Guidance codes

If you are coding interventional Radiology facility, you will come across imaging guidance codes. There are different guidance like CT (computed Tomography), MRI (Magnetic Resonance Imaging), Fluoroscopy, Ultrasound and Stereotactic guidance. If you see the last 2 or 3  years updates,  most of the imaging guidance have been bundled with the procedure codes. For example, the breast biopsy Codes, the epidural spinal injection codes, Paracentesis, Thoracentesis codes etc.

I have done lot of errors in coding wrong guidance code. While coding a vascular procedure I have used a non-vascular ultrasound guidance 76942 code instead of vascular ultrasound guidance CPT code 76937. This is very big error in medical coding. Similar mistake I have done in coding Fluoroscopy guidance. I have done lot of mix-up in coding imaging guidance codes. Do follow the below step while using them.

 Procedures              Vascular         Non-vascular (injection, biopsy)                   Spinal 

Ultrasound                 76937                        76942                                                               76942

Fluoroscopy                77001                       77002                                                                77003

Errors in Vascular Catheterization Procedures

Coding vascular procedures have always been tough. Though I used to follow all the selective and Non-selective catheterization rules, but still i used to miss a code. I would recommend every coder to understand the vascular family (Appendix L) first and then go ahead with coding this facility. 

Since, now most of the procedures like angiography and RS&I (radiological supervision and interpretation) are included in selective and non-selective catheter placement of extremities, the process of coding has become easy. Even the interventional procedures like the angioplasty and stent placement procedure codes have bundled up most of the services. 

I have missed coding add-on codes like 36218 and 36248, since it was really confusing to use them. Use of 59 or X modifiers is very common in these procedures, if you are using same CPT code again. 

Silly Errors in CPT coding

Being a medical coder, I have always used an ICD 10 code which fulfills the medical necessity for a procedure code. But, there  are cases where the ICD 10 codes is correct and the procedure code is wrong, even though it fulfills the medical necessity. These are very silly errors I have done, when I was not confident about the technique performed .

For example,  the  barium swallow and modified barium swallow procedure code, which is little difficult to understand until you have coded them before. Similarly, the bone scan procedures in nuclear medicine section are little tricky to code in radiology facility.

I have been a victim, most of the times and coded wrong codes for these procedures. Even the documentation use to confuse us, like the header of exam use to say CT head without contrast 70450 but the technique says ‘the CT exam of head is performed with the use of IV (intravenous) contrast 70460.

So, documentation is also responsible for committing errors in CPT coding.

Finally, now its your turn to share the mistakes you have done while using CPT codes. I have shared some common errors in ICD 10 coding as well. Do share your thoughts in the comment section.