Here are five common mistakes you should avoid to prevent revenue loss
1. Inappropriate medical Coding:
Frequently, medical coding for evaluation/management services tends to be excessively aggressive or overly passive, leading to coding errors. These mistakes are primarily due to the misinterpretation of E/M coding guidelines and the fast-paced nature of the clinical environment. Aggressive coding arises when there is insufficient documentation to support the provided services, while passive coding fails to consider the full scope of the work performed.
2) Missing E/M Codes:
Many times, this occurs due to incomplete charting, often caused by distractions experienced by the healthcare providers. When charts lack proper follow-up, it frequently leads to delayed claim submissions or even unbilled claims.
3. Inaccurate Capturing of status:
The uncertainty regarding a patient’s status as new or established, a determination typically made at the front desk, can result in reduced payments if the patient’s status is not accurately recorded.
4. Missed Administrative procedure code
Providers frequently overlook administrative procedure codes for minor treatments, resulting in a significant loss of revenue. This oversight encompasses codes for procedures like injections, immunizations, immobilization, and more. Administering injections is one of the most routine services in primary care or urgent care practices, but it requires two codes: a CPT code for the injection itself and a separate code for the medication or vaccination provided. Additionally, if other care is provided simultaneously, Modifier 25 may also need to be applied. Another example of this oversight is when applying a splint on a limb, requiring the entry of two codes: one for the application and another code for the supply item, such as a splint or cast.
5. Inaccurate Utilization of Modifiers
The primary mistakes arise from the incorrect utilization of modifiers 25 and 59 to extend treatment, which may result in audits and clawbacks. Modifier 25 should be added to an E/M code to indicate a noteworthy, distinct additional service provided during the encounter, such as an injection. Meanwhile, Modifier 59 is utilized to identify procedures or services other than E/M services that are not typically reported together but were suitable to perform under the given circumstances.
Medical coding precision is among the most intricate and frequently vexing responsibilities that doctors and staff must undertake. Incorrect coding can impose substantial financial strain on a medical practice, leading to reduced revenue, audits, or even clawbacks from private insurers and revenue audit contractors.