Common Coding Errors

Three of the most common billing mistakes are up-coding, duplicate billing, and having incorrect information, or typos. Up-coding is where a procedure is improperly charged to one code which represents a more severe diagnosis or treatment. This is illegal and can cause bills to be inflated. This can also happen when a name brand medication is charged when a generic one is used. This billing mistake is sometimes done purposefully to allow for higher chargers to the insurance companies for higher payments to the practice/physician. A solution for this is to have an outside party perform the billing instead of it being done in house. If proper charts and information are taken, then the billing party would bill for what was actually used and would not try to inflate the bill. Duplicate billing can occur when procedures, or services, are billed multiple times. For instance, a medication is billed upon being prescribed, and then again when actually administered. This can happen also purposefully, and illegally, like billing for numerous first day stays at the hospital, instead of subsequent days when the first day stays are billed at a higher rate than subsequent days. Then having incorrect information, or typos in the billing process. This could be as simple as the incorrect spelling of a name that would cause an insurance company to deny a claim.

The Medicare National Correct Coding Initiative, or CCI, is a computerized Medicare system that prevents overpayment. This allows claims to be denied when codes reported together do not “pass” an edit. The CCI edit tests for unbundling, this requires physicians to report the more extensive version of the procedure performed and does not allow reporting of both extensive and limited procedures. I think that all medical systems should have this editing process to disallow practices and physicians from over charging individuals and their insurances for procedures that should be billed together.