Increase Your Medical Coding Accuracy in These Five Crucial Areas

Betsy Nicoletti, M.S., CPC September 25th, 2012

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Increase your coding accuracy in these five crucial areas to improve your revenue

Ask a physician or biller or office manager: Do you want to submit claims with accurate coding or inaccurate coding?  Of course, the goal is to accurately report services performed by selecting the CPT and ICD-9 codes that describe what was done.  Medical practices don’t intend to code inaccurately or incorrectly. And yet, the latest Comprehensive Error Rate Testing (CERT) report conducted by a Medicare contractor shows a 12.9% error rate for physician services.  Before giving in to despair, increase your medical coding accuracy in these five key areas:

1.      Review three high error codes

Performing an E/M audit on all clinicians is a daunting task, and may require an outside auditor.  Instead of a complete audit, review three office codes with a high error rate.  The CERT report found a 24% error rate for 99205, 20.8% error rate for 99204 and an 18.6% error rate for 99215.  Run a frequency report for each clinician, and select records to review coded with these three codes.  If your office doe not have an experienced auditor, have a biller/clinician team review the notes using an audit sheet.  Educate clinicians who are billing these codes if they are missing required components.

2.      Seek out cloning

Only Dolly the sheep should be cloned, not medical records.  We can paraphrase the Supreme Court here in defining cloning, “I know it when I see it.”  The Office of Inspector General calls these identical E/M notes, and these identical notes are an area of interest on their current Work Plan.  Identical or cloned notes consist of notes in which some or all of the note is copied from a previous note/visit or when all of the notes are so similar to one another that they appear identical. 

 It is easy to determine if notes in your practice give this appearance.  Select two patients who have been seen three or more times in the past year.  Review three of the notes.  Although the past medical, family and social history may be identical from one note to another, and the exam similar, the history of the present illness should reflect what the patient said at that visit, or the status of their problems since the last visit. The assessment and plan should describe what happened at this visit and should not be identical to the previous note.  Use this same strategy to look at visits scheduled for the same condition on different patients. Do all patients with the presenting problem of frequency have the exact same documentation?

3.      Replace non-specific diagnosis codes

Non-specific diagnosis codes can cause claim denials and require appeals.  Using non-specific codes will also make the change to ICD-10 more difficult.  Run a diagnosis frequency report of your 50 most common diagnosis codes.  Look for non-specific codes, which often end in .8 or .9.  Each week, select five non-specific codes and provide clinicians with more specific codes and education about using them.

4.      Use correct NPI numbers

It is both a mistake and a compliance error to bill all services provided by a Non-Physician Practitioner (NPP) to Medicare using the physician’s National Provider Identifier (NPI) number.  For Medicare, the services must meet incident to guidelines. Many state Medicaid programs require practices to bill NPP services using their own, not the physician’s NPI.  Commercial insurers may or may not enroll and credential NPPs.  If the commercial payer does not, then submit the claim under the physician’s NPI.  Check first.  Do not bill for new clinicians under another clinician’s NPI while waiting for enrollment.  Accurately reflect the NPI number of the performing clinician according to Medicare and Medicaid rules and payer contracts.

5.      Modifier 25 and E/M services

The final report to run to increase accurate coding is one that shows how often your group bills an E/M service with a procedure.  It should not be 100% of the time.  Report both an E/M service and a procedure, appending modifier 25 to the E/M, when the office service was a distinct and separate service and is clearly documented.  This is most likely in one of two instances:  There were two separate problems, or the evaluation of the problem was extensive.  Do not report an E/M service for a planned procedure or for a minor procedure that required only evaluation of the site and the decision to perform the service (wart destruction, for example).  If the documentation reads, “Patient presents today for a LEEP because of an abnormal pap smear,” bill only for the LEEP. 

 Medical practices can decrease coding errors.  Focus attention on these five areas and experience a high return on your time investment.

 Betsy Nicoletti, M.S., CPC, is the founder of, a wiki for physician reimbursement. She is a nationally known speaker and consultant, and can be reached at She recently wrote for Getting Paid on Seven Ways to Improve Your Patient Collections.

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