What problems might occur if proper coding procedures are not used?
Coding Errors May Lead to Fraud and Abuse Fines The consequences could be a monetary penalty or a legal issue if the claim is named fraudulent. To prove fraud occurred rather than abuse, the upcoding or miscoding of an event must occur over time and across a large number of patients.
What should you do if a provider asks you to code for procedures that were not performed?
Contact the provider. It could be an error that your provider will correct, or he or she may explain why the coding is correct. If you have Medicare and need help, you can contact your local Senior Medicare Patrol (SMP).
What are some common procedural coding mistakes?
Related Coverage
- Unbundling codes.
- Upcoding.
- Failing to check National Correct Coding Initiative (NCCI) edits when reporting multiple codes.
- Failing to append the appropriate modifiers or appending inappropriate modifiers.
- Overusing modifier 22, Increased Procedural Services.
What is the impact to coding due to the incomplete clinical documentation?
One of the most significant effects of incomplete documentation in a patient’s medical record is inaccurate reimbursement that results in inaccurate gross revenue to the provider. In the absence of accurate documentation, a provider should assume that revenues are not accurate, as well.
What modifier do you use for a failed procedure?
Modifier 53 applies if the provider quits a procedure because the patient is at risk. In other words, the provider does not so much choose to discontinue the procedure, as sound medical practice compels him or her to do so.
How would you prevent coding errors if you or someone you manage were responsible for coding in the medical practice?
Ensure Patient Information is Correct and Properly Aligned with Data.
What are five common coding and billing errors?
5 Most Common Medical Billing and Coding Errors
- Not Enough Data. Failing to provide information to payers to support claims results in denials or delays.
- Upcoding.
- Telemedicine Coding Errors.
- Missing or Incorrect Information.
- Incorrect Procedure Codes.
What is procedure code 99255?
CPT® 99255, Under New or Established Patient Initial Inpatient Consultation Services. The Current Procedural Terminology (CPT®) code 99255 as maintained by American Medical Association, is a medical procedural code under the range – New or Established Patient Initial Inpatient Consultation Services .