Common coding errors can cost your practice

Figuring out what those errors are and educating your staff on better coding and documentation methods can mean fewer denied claims.

By Julie A. Jacob, amednews staff. July 2, 2001.

No supporting documentation, missing signatures, invalid codes and misinterpreted abbreviations are some of the most common physician coding errors, says a Web site devoted to coding issues.

Other mistakes included in Justcoding.com's top-10 list of coding errors are billing for a consult instead of an office visit, failing to list a chief complaint and billing services included in a global fee as a separate fee.

Top coding errors
Links

The list of errors was based on feedback from consultants who work with physician offices, said Ruthann Russo, executive director of HP3 Healthcare Concepts, a reimbursement and coding consulting firm in Bethlehem, Pa., that owns Justcoding.com.

Although coding errors are usually from minor mistakes, they can add up to a lot of lost revenue, Russo said. She cited the case of one 200-physician multispecialty group in which doctors had not received any in-depth education on E&M coding.

"We estimated that by incorrect coding practices of E&M levels assignment, clinicwide they were leaving over $10 million unbilled," Russo said. "We felt this was a very conservative figure. We did multiple group training and individual training with the doctors and saw extreme improvement in documentation and reimbursement."

Mary Stanfill, a coding practice manager for the American Health Information Management Assn., said she "would advise a physician to be proactive and find out how the claims are going and to see if they have a lot of fixable, common errors that they can head off."

90% of coding errors are due to mistakes in processing claims.

About 90% of coding errors are due to mistakes in processing the claims form, Russo said. For instance, she said, doctors working in emergency departments may fail to write down the chief complaint because they think the coding staff can use documentation from the registration form.

"But they can't -- the coding can only be based on physician documentation," Russo said.

Experts say, however, that physicians can reduce coding errors by:

Educating themselves on proper coding.
Hiring a well-trained billing staff.
Continously assessing coding procedures to identify the most common errors and reduce them.

"The biggest thing is to educate physicians on what is important, what they must do to correctly code and to make sure that their coders get their CPC [certified professional coder] designation through the American Academy of Professional Coders," said Jim Gibson, vice president of Comforce, a health care staffing and recruiting company in Addison, Texas.

It's also important that physician offices use up-to-date coding reference materials, he said, and provide enough supporting documentation.

Doctor offices use many approaches to cut down on coding errors.

The Central Ohio Primary Care Group, a 105-physician group in Columbus, conducts an ongoing internal audit of coding procedures to make sure that claims are coded correctly, said Bruce Wall, MD, the group's medical director. The group also holds coding education seminars for physicians and staff, he said.

The 23-physician Texas Gulf Coast Medical Group in Houston also holds coding education workshops for its physicians and billing staff, said Susan R. Waldron, the group's executive director. The medical group also conducts periodic revenue team meetings in which the physician, nurse, front desk representative, scheduling department representative and business office supervisor discuss claims documentation and billing issues, she said.

What the group has discovered, Waldron added, was that its physicians "tend to undercode, rather than overcode."

Dr. Wall said he had noticed the same thing. "The rules are complex and, for fear of being perceived as doing the wrong thing and because they are not sure what the rules are ... physicians frequently undercode."

Stanfill suggested that physicians talk with staff members who process claims to find out the most common reasons that claims are denied or sent back for additional documentation. "That will give them a priority list of what they can do," she said.

Then, she added, physicians and their staff need to "use whatever tools [coding software, reference and educational materials] you have available to make the process easier."

ADDITIONAL INFORMATION:

Top coding errors

Failure to document services billed.
Failure to provide signatures.
Consistent assignment to the same level of service.
Billing as a consult rather than an office visit.
Use of invalid codes (for example, codes taken from an outdated resource).
Unbundling of procedure codes.
Misinterpreted abbreviations.
Failure to list chief complaint.
Billing as a separate professional fee those services included in a global fee.
Use of an inappropriate modifier or no modifier for accurate payment of a claim.

Source: Justcoding.com