How Much Do You Know About These 3 Common Coding Errors?

by  Find-A-Code™
Jun 12th, 2023

Medical coding errors are to be expected given the complexity of our modern coding system. What is not expected is the same errors occurring time and again among a single set of coders. But it happens. It might happen even more frequently than most people realize.

A February 2023 piece published by Medical Economics suggests that many of the issues related to CPT and ICD-10 codes are common to providers across the country. Coders seem to have the same questions. They appear to make the same mistakes. To illustrate the point, the article mentions three medical coding errors described below. How much do you know about them?

1. Unbundling Medical Codes

The term 'unbundling' may cause people outside the medical billing community to think about car insurance. After all, insurance companies are constantly talking about bundling products and services. But where health insurance and medical coding are concerned, bundling and unbundling have completely different meanings.

There are certain types of procedures that can be bundled under a single code. In an unbundling scenario, those services are coded and billed separately. Sometimes unbundling is the result of misunderstanding CPT codes. Other times, coders are instructed to unbundle in hopes of increasing the total billed amount. In either case, unbundling can lead to rejected claims.

2. Undercoding

Undercoding is an error related to not accounting for all the services rendered during a billed visit. Once again, it can be the result of misunderstanding or ignorance. But undercoding can also be done purposely. When that is the case, providers may be attempting to stave off an audit.

Regardless of the underlying reasons, undercoding only hurts the provider's bottom line. Direct harm is done by reducing revenue for billed services. Indirectly, harm results from inaccurate claims data that can lead to lower reimbursement rates over time.

3. Overcoding

The opposite side of the undercoding coin is overcoding. Overcoding is the result of utilizing CPT or HCPCS codes that lead to higher bills than would otherwise be generated. Overcoding can be accidental or intentional. If it is accidental, steps should be taken to limit future overcoding as much as possible.

Intentional overcoding is another matter altogether. A repeated pattern of overcoding can very easily trigger an audit. That is the least of a provider's concerns. If an audit reveals an intentional act to inflate bills by overcoding, a provider could be sued for fraud.

Other Common Errors

The three medical coding errors described here are fairly common yet not talked about a lot. Some of the other common errors mentioned in the Medical Economics piece are just the opposite. They are well known and talked about quite frequently. At the top of the list is relying on outdated code sets.

The most utilized code sets – CPT, ICD-10, and HCPCS – are subject to routine updates by their respective maintainers. Not only that, but code set updates are also typically released well in advance of becoming official. Medical providers, coders, and billers all have advance notice as well as plenty of opportunity to update their resources.

The good news in all of this is that a few errors from time to time do not constitute the end of the world. Whether you are a physician, medical coder, or billing specialist, the complexities of the system make it impossible for you to go your entire career without making mistakes. Don't sweat it. Do your best to do everything by the book. If you maintain updated resources and play by the rules, any unintentional mistakes you do make can usually be corrected.