Are the medical coders in your healthcare organization diligent and detail-oriented? Do they communicate well and stay sharp? Are they all certified and experienced?
If your answers are all yes, that’s one giant step in the right direction. While the above questions may sound obvious, they are questions every coding leader should be asking often.
If the answer is no — or somewhere between yes and no, education and internal quality checks are excellent ways to create change and improve coding performance.
Here’s a simple truth, though. Even rock star coders sometimes make mistakes that can cause claim denial rates to increase and put revenue at risk.
Here are four common mistakes your coders may make, and the steps you can take to prevent them.
A veteran medical coder may get too comfortable with his or her work, operating on autopilot. Perhaps your coder has seen these particular types of visits thousands of times and has the codes memorized.
They might feel that there is no value in spending the extra time to look up the codes because they know them already. But what happens if, or rather when, the codes are updated, replaced, or expanded? Coders may not have all of the ICD-10 codes memorized yet, so they are likely not operating without focus. However, they may get comfortable with a certain level of specificity versus actually taking the time to thoroughly read provider documentation and code to the highest level of specificity supported.
A common coding denial results when the coder selects the wrong code based on the new or established patient guidelines. This type of error is indicative of taking the time to check all of the details and read the entire chart not just the header. Another common example is when a procedure is coded as ‘routine’ instead of correctly coded as ‘diagnostic’. Most denials like this are a result of missing details in the medical record. The good news is that these types of common denials can most likely be easily prevented by simply double-checking work. If quality is emphasized and a coder’s performance is evaluated regularly, coders will pay more attention to the details they need to accurately code.
If you are trying to get somewhere fast, you might try taking a shortcut. Sometimes a shortcut works great, but other times you get lost or arrive at a dead end. Retracing your steps takes twice as long as it would have if you would have just listened to Siri and taken her route from the outset. In coding, taking shortcuts may save some time, especially when a coder feels overwhelmed by a large backlog of work.
But fixing the mistake after the fact is more costly and time-consuming than having done it right in the first place. This is especially prevalent when providers are selecting their own charges. A coder may think it is faster to simply enter the codes associated with the charges without reviewing the provider's documentation.
For instance, the patient was seen for a laceration repair and the finger was splinted. If the provider forgot to include the finger splint in the list of charges and the coder doesn’t verify the documentation, your practice just gave away a free splint. Conversely, if the provider selects the laceration repair but does not document it sufficiently, an unsupported charge is billed. More examples of how important it is for a coder to carefully read the documentation and code only those procedures and services that are supported by the provider’s documentation.
Poor Management Strategy
Any of the above mistakes can quickly compound and wreak havoc on your coding accuracy. A strong coding leader is constantly looking for process improvement opportunities in the coding workflow by evaluating what is working well and what isn’t. He or she also supports continuing education sessions with the coding team. Analyzing denial reasons, identifying trends, building system edits and reviewing patient complaints all present opportunities for improvement.
The Bottom Line
To avoid common medical coding errors, the key is for coders to thoroughly review all provider documentation prior to selecting the appropriate codes. There is no substitute for this. Additionally, coding leaders should continuously review processes and workflow strategies to ensure the running of a high-quality coding department.