Groups » Common Medical Coding and Billing Errors and How Professionals Can Avoid Them

Medical coding and billing may not seem to be a significant part of healthcare, but that’s far from the truth. Making simple mistakes while filing medical records can create much confusion and can involve unnecessary treatment and tests in the future. What’s more, with healthcare providers receiving the majority of their revenue from successful claims, even the smallest of errors could cost organizations in this sector dearly.

Coding and billing specialists do work diligently, as they understand the impact their errors can have on patients and on the healthcare organization’s bottom-line. However, there’s always a heavy workload, and making medical coding and billing processes error-free can prove to be hard.

There is also the opportunity to commit billing fraud, and according to Oberheiden health care fraud defense lawyers, this is a common type of healthcare fraud allegation. So even if you’re an honest coding and billing specialist, you might find yourself in trouble for a simple slip-up.

Avoid such instances by being aware of common coding and billing errors, and taking the right steps to minimize and eliminate mistakes.

Common Coding Errors

Transforming healthcare diagnoses, procedures, services, and medical equipment into alphanumeric code definitely requires a lot of concentration and hard work. Read on for some common medical coding errors to stop yourself from making them.

Using Wrong Codes: There are numerous codes used to represent various diagnoses, procedures, and more. As such, it is possible for healthcare providers to use wrong codes unknowingly. Not reading editorial comments at the beginning of different sections or notes mentioned near codes can also lead to errors. Moreover, inaccurate or incomplete code descriptions on cheat sheets, encounter forms, and electronic charge systems can be a significant source of error.

Misusing Modifiers: Modifiers are two-digit codes that are added next to procedures or services to explain special circumstances to the bill payer. There are two types of modifiers – CPT (numeric) and HCPCS (alphanumeric or alphabetic) developed by the American Medical Association (AMA) and Centers for Medicare and Medicaid Services (CMS), respectively. Randomly applying a modifier or mistaking a modifier for the other type are common mistakes made by coders.

Incorrectly Linking Codes: Diagnosis codes explain the reason why a particular treatment or service was given, while CPT and HCPCS codes denote the type of service received. A patient’s visit to a hospital or clinic is likely to involve more than one procedure and service, in which a coder might ascribe the wrong diagnostic code to a CPT or HCPCS code.Common Billing ErrorsMedical billing errors can be difficult to spot and even tougher to fix. Here are some common billing mistakes you can easily avoid.

Duplicate Billing: This occurs when services and procedures are billed multiple times when they were provided to the patient just once. For example, a patient could be charged twice for a procedure because both the doctor and the nurse indicated it, or a patient could be charged for the same medication twice.

Not Verifying Insurance: It’s the number one reason for denied and rejected claims and can cost you, the healthcare organization, and patients time and money. Claim denials associated with insurance verification usually are a result of members’ coverage being terminated, members having met maximum benefits, services not being covered by the plan, or services not having been authorized.

Balance Billing: Balance billing can be tricky because it can be legal at times and illegal when it’s not required. It occurs when a healthcare provider charges a patient above and beyond their co-insurance, co-payments, and other amounts assigned by their insurance company. Balance billing is illegal when care was provided by an in-network physician or hospital, or when the service is covered by the insurance and the company has a contract with the healthcare provider. The practice is common when a patient is treated out-of-network for non-emergency care, and is permissible when services received aren’t covered by the patient’s insurance.

Tips to Avoid Errors

✓ Use the correct medical codes and stay up-to-date. Make use of current procedures and diagnosis codes. Also, avoid truncated codes so as to provide highest level of specificity.

✓ Read all chart notes carefully.

✓ Always verify insurance. Contact the insurance provider and confirm effective dates and coverage period. Assess co-payments and deductibles, and check exclusions, if any.

✓ Coordinate with other healthcare providers – or other coders and billers, nurses, and doctors – so as to avoid errors like duplicate billing. Clarify issues before submitting claims.

✓ Never ignore errors, no matter how small. If you detect a spelling mistake in a patient’s name or spot a coding error, correct it promptly before submitting the claim.


Medical coding and billing involves an excessive amount of work, and at times, small mistakes are bound to happen. These mistakes can not only lead to poor patient care and trouble related to reimbursements, but can also pose a problem to those responsible for these errors.With the information provided here, you now know the common types of coding and billing errors, and what you can do to minimize and eliminate them. So get started on doing the right things and you’re sure to avoid common billing errors while doing your job.

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