Avoid Costly Coding Mistakes. Don’t Skip the CPC Review
Medical coders truly are unsung heroes. It is their job to know the ins and outs of complex medical coding guidelines and stay up to date on rules and regulations.
A certified medical coder’s input is critical for ensuring claims are complete and compliant to obtain optimal reimbursement without costly fines or denials. In other words: don’t skip the certified professional coder (CPC) review.
When providers are charged with selecting codes without a CPC review, it is easy to miss charges such as vaccines, EKGs, and other services performed during a visit. Common mistakes and coding errors ─ including upcoding, undercoding, or unbundling ─ can lead to compliance issues that may break federal laws or lead to denials that delay payment. Certified professional coders basically do mini-audits which capture what providers miss.
Common Coding Mistakes
- Not coding to the highest level of ICD-CM specificity.
- Not being familiar with coding guidelines that require combination codes.
- Combination codes must be specific and cannot be reported separately (For example, E11.22 is Type 2 diabetes mellitus with diabetic chronic kidney disease. E11.9 is Type 2 diabetes mellitus without complications. N18.9 is chronic kidney disease, unspecified).
- Signs and symptoms should not be coded if there is a definitive diagnosis (For example, if a patient has the flu, you shouldn’t code for cough and fever).
CPCs are Credentialed to Prevent Costly Errors
CPC credentials mean a coder has expertise in documentations reviews, is proficient in coding, and is current with compliance and regulatory requirements. A CPC’s education is ongoing, with annual CEU requirements.
Anatomy of a Coding Review
After a provider selects their codes, a CPC will review and make necessary changes after reviewing progress notes, ancillary services, specific insurance requirements, and other pertinent documentation. Some providers will want to do a final review to ensure coding is correct for the office visit level.
The Cost of Coding Denials
The costs for ancillary services and levels of service vary; however, CodeEMR has developed a formula to illustrate the potential high costs of claim denials. When you add fines associated with compliance issues and take-backs from insurance companies, the ROI for incorporating CPC reviews into a practice can be substantial.
CodeEMR Can Help
CodeEMR’s certified professional coders partner with practices and facilities to ensure coding is accurate and achieves maximum reimbursement without denials.
Contact CodeEMR to learn how our services can be customized to meet your specific needs.
