MEDICAL CODING & BILLING ERRORS AND MANAGEMENT: A LITERATURE REVIEW Ms. Jyothi M Borkar

Medical coding is the conversion of procedures, healthcare diagnoses, medical services, and equipment into medical alphanumeric codes. International Classification of Diseases (ICD) codes represents a patient’s injury or sickness. Current Procedure Terminology (CPT)codes, which relate to functions and services the healthcare provider performed on or for the patient. HCPCS level II are used to code health care equipment & supplies. Every code has its own set of rules and guidelines. Code should be placed in a particular order. Medical biller will bill for service provided on the basis of the codes report. Making even a negligible mistake may lead to significant time lost tracking down the source of mistakes, and serious delays in payments. The review objective was to determine the medical coding & billing errors and management among medical coders and billers. In this study literature review and qualitative telephonic interview method is used to identify the medical coding & billing errors and to know its management. Relevant article for the review of literature was selected by setting includes, using key words. A telephonic interview of 30 medical coders and billers was done to add on errors and management. Consent was taken before proceeding to the interview.
This paper found major medical coding errors could be due to insufficient documentation, incorrect coding, appending incorrect modifiers, coding rules and guidelines, medical coders background, physician’s attributes, lack of knowledge on medical terminology& anatomy, etc. Regular audit, linking data base to easy data capture, utilizing computer assisted coding, using tools like encoder, ICD 10 data, training of medical coder/physician on- coding and billing, medical terminology, anatomy, proper & complete documentation ,checking National Correct Coding Initiative (NCCI) edits for multiple coding, developing clinical documentation improvement team, etc will help to reduce the errors.
Medical coding and billing errors are unavoidable. But can reduce and manage it by knowing the reasons behind the errors. Reducing and managing medical coding and billing errors has great impact on revenue of the organization.
Future research could be in the area of computer assisted coding and variability in the productivity among medical coders, automated coding and variability in the productivity due to medical coder related factors, or also could be like automated coding and specific department wise productivity among medical coders.