8 most common medical coding errors

By Morgan Haefner for Becker’s Hospital Review

In June, federal officials charged 601 defendants in alleged schemes involving about $2 billion in costs to Medicare and Medicaid, the biggest healthcare fraud enforcement action in U.S. Justice Department history.

Government and private health insurer audits have recently revealed several fraudulent or abusive medical billing practices, Kevin B. O’Reilly, editor of AMA Wire, said. Providers need to ensure proper billing practices not only to avoid fraud, but to maintain a profitable business.

Here are eight of the most common medical coding errors identified by the American Medical Association:

1. Unbundling codes, or using multiple CPT codes for parts of a procedure
2. Upcoding
3. Failing to check National Correct Coding Initiative edits when reporting multiple codes
4. Not appending the appropriate modifiers, or appending inappropriate modifiers
5. Overusing modifier 22 — increased procedural services
6. Improper reporting of time-based infusion and hydration codes
7. Improper reporting of injection codes
8. Reporting unlisted codes without documentation