{"id":823,"date":"2013-09-11T13:15:03","date_gmt":"2013-09-11T13:15:03","guid":{"rendered":"http:\/\/www.medicalbillingstar.com\/blog\/?p=823"},"modified":"2017-02-14T07:20:51","modified_gmt":"2017-02-14T07:20:51","slug":"the-hallmark-solutions-to-frequent-medical-coding-gaffes","status":"publish","type":"post","link":"https:\/\/www.medicalbillingstar.com\/blog\/the-hallmark-solutions-to-frequent-medical-coding-gaffes\/","title":{"rendered":"The Hallmark Solutions To Frequent Medical Coding Gaffes"},"content":{"rendered":"

\"cloud-fluffy-lamb\"<\/a><\/p>\n

Most healthcare providers are on the horns of dilemma due to the medical coding mistakes and the ensuing claim denials. The Best Medical Coding Practice paves the Greenway to recoup your dollars <\/a>for the exact service rendered by you, whilst improper coding takes away your dollars. This article underscores the common coding mistakes and the conduit to resolve them.<\/p>\n

Ensure Medical Necessity :<\/span><\/h2>\n

The healthcare insurance payers are progressively more apprehensive about the medical necessity. The payment for the physician services is based on the CPT codes<\/a>, whereas the claim approval and reimbursement by the payer is based on the diagnostic codes. Thus, elucidating the harmony between CPT and diagnostic codes is a key step in the coding process. If the payer deems that the service is medically necessary, you will be paid or else your repayment will be hampered and\/ or even you will be monetarily penalized.<\/p>\n

Ethically Exploit the Modifiers :<\/span><\/h2>\n

A Modifier is the Nucleus of Multi-procedure Coding-based medical claim. Modifiers can be the benchmark for full reimbursement – abridged reimbursement – complete denial – or partial denial. Forgetting, abusing or confusing modifiers in requisite circumstances may lead to negative impacts on reimbursements.<\/p>\n

Examples :<\/span><\/h2>\n

1. Failure to tag on Modifier 25 to the E&M service<\/strong> or erroneously appending it to the surgical procedure will cause claim denial.
\n2. A CPT code linked with Modifier 51 notifies the payer that two or more procedures are being done on the same day and to employ the multiple procedure payment formula. Modifier 59 tells that the procedures\/services those are not usually reported collectively, but are apt under a specific circumstance.
\n3. CPT advocates using Modifier 24 with an \u201cunrelated E&M service by the same physician during a postoperative period.\u201d<\/strong>
\n4. Modifier 53 is tagged on, when the physician opts for ceasing a surgical or diagnostic procedure because of extenuating events or a hazard to the patient\u2019s health.<\/p>\n

Shun Missed Charges :<\/span><\/h2>\n

Most biggies among healthcare providers, can simply fail to spot charge captures for the multiple services delivered. Imaging, laboratory and other subsidiary services often miss the unwritten\/ verbal orders of the clinic or lab staff. Better avoid or document the \u2018verbally communicated orders\u2019 so as to rule out this problem.<\/p>\n

Take Cognizance of the Code Revisions :<\/span><\/h2>\n

Many providers use out-of-date encounter forms thinking that updating is an onerous and mind-numbing task. But, it is inevitable to update the Superbills with the revised codes so as to recoup your payment for the rendered service. Every year, procure new CPT, HCPCS and ICD-9 books and educate the pertinent staff members to get accustomed with the revised codes.<\/p>\n

Eschew \u2018Over-coding\u2019 and \u2018Under-coding\u2019 :<\/span><\/h2>\n

Over-coding is sometimes deliberately done to acquire a higher reimbursements, but it may lead to claim denial and often resubmission or appeal processing\/ penalty cost<\/a> more than that of the anticipated payment.
\nExample: If, the code 413.9 (unspecified angina pectoris) is used along with 414.01 (Coronary atherosclerosis of native coronary artery), instead of 414.01 alone, it is \u2018over-coding\u2019<\/strong> and would be considered as a fraudulent activity by the corresponding statutory authorities.<\/p>\n

Under-coding is usually a result of \u2018fear for denials\u2019. The best solution is to do ethical coding using coding and quality control veterans. Besides, perform NCCI (National Correct Coding Initiative) or other appropriate edits to ensure correct coding and to control the inappropriate assignment of codes that result in improper reimbursement or penalty.
\nExample: Some physicians consider 99213 as the default code as they believe much documentation will be desired for coding anything higher and they deem 99213 is the safe and sound option. But, in point of fact, this is an under-coding and culminates in diminished reimbursement.<\/p>\n

The Soul of Medical Coding Remedies :<\/span><\/h2>\n

In a nutshell, our think tanks say that the following tips can augment accurate coding, and sequentially, medical practice revenue vanished to denials:<\/p>\n

1. Keep your staff abreast of the revised codes.
\n2. Educate your staff to hone their coding skills.
\n3. Create a channelized workflow between coders and physicians.
\n4. Follow ethical coding practice.
\n5. Resubmit denials earlier and rigorously track the denied claims.<\/p>\n

Click here to have a word with MedicalBillingStar and crash the coding menace effortlessly !<\/p>\n

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