Do Physicians Make Good Medical Coders ? You don’t want to know the answer !

Despite understanding the importance of medical coding and the risks of erroneous coding practices, most physicians still have a long way to go as far as coding is concerned. It still remains a quagmire an abomination. There are several factors attributed to physician’s coding abilities or the lack of it.

And the one major reason that everybody agrees on is that physicians hardly have the time to focus on medical coding. Providing patient care and learning to work with new workflow models and technologies is taking up enough time. Physician coded medical claims have a shocking error rate. Almost 60% of physician coded data is incorrect.

Here are the major reasons why physicians struggle with assigning medical codes…

Most physicians are not trained to assign codes. With the slant being on accurate coding and documentation, a small mistake can prove to be fatal. Assigning just a single diagnosis code is not going to make the cut anymore.

To classify a patient, it takes more than a single code. Broadly classifying diseases and sticking to middle of the road coding can only result in denials. Physicians who are not formally trained or certified in medical coding are going to find it tough.

Chart abstraction plays a vital role in medical coding. Abstracting the entire medical record of the patient, to understand the diagnosis of the patient can demand a lot of time and effort. In the hectic pace of a medical practice, there is barely enough time left for chart abstractions. Diagnosis codes must be properly sequenced to avoid denials. And closely following the medical coding instructions of payers is mandatory. With so much to do and so little time, physicians are bound to make mistakes.

Picture this…

A patient recently was billed $1000 for a $299 procedure. The patient had clearly done her research, talked to her doctor’s office about her insurance plan and confirmed what her out of pocket expense would be after insurance reimbursement. The bill came as sticker shock and she couldn’t understand what was wrong.

 After months together of following up with the physician’s office and collection agency, the mistake was finally spotted. You guessed it right, the doctor had coded wrongly. He’d mistakenly assigned a code for an in-patient procedure when it clearly wasn’t. There are thousands of patients who’ve had such harrowing experiences thanks to inaccurate codes.

What are the most common coding mistakes physicians make ?

• Most physicians lack in-depth knowledge of NCCI edits. Randomly adding modifiers is one major reason for denials. Selecting the wrong procedure code, assigning just one diagnosis code when several codes will have to be sequenced and failing to cross-map and link codes are other major mistakes physicians make.
• Busy physicians miss assigning charges for several services rendered. Many medical practices do not maintain a central log and that leads to physicians missing charges. This is another revenue drainer for medical practices.
• Undercoding is another mistake that physicians make which can result in loss of revenue. Many physicians feel it is safer and they needn’t face the short end of the stick during audits. But it can lead to thousands of wasted dollars every year.

The need of the hour !

There is an increased need and demand for physicians to spruce up their coding skills. Physicians who lack coding expertise, inadvertently commit fraud and liable for heavy penalties. According to a study by the OIG as many as 42% E/M codes are coded incorrectly. 19% of medical codes lacked proper documentation. Upcoding and downcoding errors were prevalent in most medical claims.

The OIG identified that physician coding education is a critical component in establishing best coding practices. Physicians should either educate themselves on coding rules or let coding professionals handle their medical coding and auditing needs.