Medical Coding may seem like an easy job, but there are a lot of intricate details that a medical coder needs to vary of. There is a lot of space for mistakes that can create massive problems. Medical coders must be cautious when coding and avoid the following five coding mistakes:

5 Medical Coding Mistakes That Could Cost You


Upcoding is when a patient has to pay for a procedure they didn’t receive. These procedures are more complicated and come at a much higher price in most cases. When a patient is billed for these procedures, they are often in a very bad position. This mistake usually happens when a coder misinterprets the service a patient needs from a specialty doctor.

They believe that the patient has to receive the highest level of treatment available, which leads to upcoding. This can also be directed to fraudulent activity from the physician’s end. There have been instances where physicians claimed to provide services they didn’t provide at all.

Incorrect Information

Failure to include correct information can be the biggest mistake on behalf of the coder. It is their responsibility to have accurate and complete information. Small blunders can result in much bigger problems. Common mistakes include the wrong patient name, date of birth, the dates of the treatment, and insurance details, among others.

These mistakes are usually avoided with proofreading but can still make their way to the final reader. Billing employees must investigate the information they receive and keep an eye open for mismatches. If they don’t do this, they will be responsible for a claim denial. These problems are usually small and overlooked by all departments, which is why a coder should be extremely vigilant with the basic information first and then move on to the more advanced details.

Flaws in Procedure Codes

Typos are inevitable; you can make an incorrect entry of the procedure code with a simple typo. Such a mistake can be from the back end too and overlooked by the coder. It is possible that the information is not accurately documented on the encounter forms and even on the documents that come with it.

Incorrect procedure codes can also result from failure to follow the latest coding rules. Coding rules change frequently, and your medical coding team must be familiar with all the rule changes. If such mistakes go through to the insurance company, hospitals will have to reimburse the patients. Hospitals can invest in training sessions for their codes to minimize such mistakes. Educational programs can reinforce the old coding laws and teach the newer additions to eradicate any possibilities of errors.

Check NCCI Edits For Multiple Codes

The National Correct Coding Initiative is important to understand and learn for all medical coders and billers. Centers for Medicare and Medicaid came up with the coding initiative to ensure that coders everywhere followed the accurate methods. These methods were devised to certify that there were no incorrect payments as claims. The repayment edits are analyzed when all codes are analyzed, and the same patient is billed. They should also be for the same service date and provided by the same provider.

An NCCI edit exists if any of the codes are denied. The NCCI will also provide CPT modifiers to override denial. An example of this includes incomplete coding and limited to superficial procedures. This can cause misunderstanding, and the patient might not be billed for all the services they received.

Lack of Data

As a medical coder, it is your responsibility to record the complete information. You must keep track of all the doctor appointments and all the procedures that the doctor has prescribed. If a coder fails to do this, they will not have ample information to make the bill.

This can result in delays of payment and insurance denial, which can be bothersome for both the patient and the insurance company. It might also lead to medical negligence where the patient cannot get the treatment they need. There can be multiple reasons for such a mistake. For example, an employee might have made a mistake, or the physician might not have given the correct information needed to code.

Are You Prepared For A Medical Coding Job?

Many people opt for medical coding as a career option, but hardly a handful of them are able to do it any justice. While mistakes can be inevitable, there are some things that a medical coder can do to avoid making such mistakes. The first and foremost is to get all the necessary education needed to code properly. You cannot start looking for medical coding jobs if you do not have the right qualifications. You might not be able to get an opportunity as medical coding is a job that requires rigorous training.

Furthermore, you must be very vigilant and available to ensure that you do the job properly. Mistakes when coding, can lead to problems that might not have a solution, which is why a candidate must avoid mistakes, at all costs. A successful practice trains you to steer clear of such issues.