![]() ![]() Robust, ongoing training is, of course, the answer to lowering error rates across the board.Presentation on theme: "The MEAT of Documentation"- Presentation transcript: Knowing the pitfalls is the first step in avoiding these common “newbie” errors. A payer will deny coverage if the patient’s age, date of birth, sex, or address are incorrect. This is one of the most common billing errors, so it stands to reason that new coders are often guilty of it. Modifier 59 indicates that the physician performed a second procedure that is bundled into the first and meets the requirements of a separate, distinct service. Modifier 51 indicates that the physician did two procedures on one day, and that the second is not a component of the first. If the state or the patient provided the medication, bill only for the administration. When the practice purchased the medication for a therapeutic injection, immunization, or allergy shot, bill for both the medication and the administration. Learn and know your modifiers as to when and why they are used. It is important for all billers and coders new and old to understand that because a modifier got it paid once, it is not always correct. Of course, simply adding modifier 25 to all E/M services is not acceptable. It’s important to add the modifier to the E/M service, not the surgical procedure. Modifier 25 indicates that a separate, significantly identifiable evaluation and management (E/M) service was performed on the same day as a procedure. Many programs also have scrubbing features to catch this. If you check your acknowledgement reports from clearinghouses, you will be able to see that claims were rejected in the front end for this reason. Entering too few or too many digits for ICD-9-CM codes.įamiliarity means experienced coders will usually realize they’ve entered the wrong amount of digits, not so with new coders. ![]() This is not when you want to explain that you knew and did not feel comfortable to address your questions. If not, claims and dx will not be challenged and this will result in decreased revenue. It is imperative that you find the comfort zone to do this. Incomplete or abbreviated descriptions often lead to incorrect code selection, and new coders may not feel comfortable seeking additional information from the provider. Basing code selection on an abbreviated description. It is important to understand that coding and billing is changing rapidly and that you are aware of those changes, guidelines, and that the person training you is. New coders, especially those using electronic coding systems, may not seek out these valuable paper-based resources. The answers to many coding questions are hiding (in plain sight) in the editorial comments at the start of each section in the coding books. This is where auditing claims before submission is vital. It’s important for diagnostic and treatment codes to match. Payers will deny claims based on CPT (current procedural terminology) codes if the diagnosis does not support the medical necessity of the service or is not a covered indication for that service. When this is an issue measures need to be taken to correct this problem to be ready for implementation of ICD-10, which is going to take it to a level that is more complex. This is also a result of inadequate documentation to sport the dx code in the records. This is often the result of an inexperienced coder relying heavily on pre-printed encounter forms or lists of favorites. Test them on their understanding and how to handle denials before allowing them to work in this position without supervision. Emphasize this with new employees and encourage them to seek help from “old hands” for correct EOB interpretations. Let’s take a look at the top mistakes new coders make so you can avoid them:Įxplanation of benefits (EOBs) from payers can be cryptic, and new coders may have a tough time understanding them. While it’s normal to make mistakes when you’re starting out at a new job it’s important for your practice to train new coders to understand common medical coding errors to create fewer mistakes and do-overs. As a result, many medical coders are entering the field without any prior experience. However, the field comes with a unique set of challenges, including a high volume of work and complex guidelines. Medical coding is an exciting career with a lot of room for growth.
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