There are many rules and regulations medical coders must follow for diagnosis coding. Avoiding these 10 most common errors will improve your audit rate.
10. Coding straight from the index. Read the notes in the Tabular List to be sure your selection is correct.
9. Sequencing codes inappropriately. Code the underlying disease BEFORE the manifestation; the injury BEFORE the E code.
8. Assigning too few codes. If an underlying condition is a factor in today’s treatment, sequence it secondarily.
7. Assigning too many codes. If a chronic condition isn’t part of today’s treatment or care plan, it needn’t be reported. But it should be documented once per year, such as in a wellness visit, for risk adjustment purposes.
6. Not looking beyond your code book’s guidelines. Check for annual updates to the ICD-10-CM Official
Guidelines for Coding and Reporting. Download the latest updates.
5. Coding rule-out diagnoses. For professional claims, if a test result is negative, DO NOT code the suspected diagnosis to justify the test. Symptom codes get the doctor paid without compromising the codified medical history of the patient.
4. Truncating codes. Make sure that if a condition provides for details in fourth or fifth digits that you are using them. A truncated code is an invalid code and the quickest road to a claim denial.
3. Settling for a code that is vaguely appropriate. Don’t settle for “other and unspecified” or “other specified,” unless you have exhausted all other possibilities.
2. Letting time get away from you. Make sure the code set and guidelines you are using are those for the date of service on the claim.
1. Thinking ICD-10-CM codes aren’t “money codes.” If the codes are old: DENIAL. If the codes are truncated: DENIAL. If the wrong codes are assigned or the sequencing is wrong: DENIAL, DENIAL. Denials cost money.