10/14/2024

Coding 101: Common Pitfalls and How to Avoid Them

Each stage in life has a sequence of knowledge and application. If we follow the steps, we may avoid situational pitfalls.

Medical coding, the communication mechanism for healthcare reimbursement and the standardization of uniform language for nationwide claims processing of medical, surgical, and diagnostic items and services, can be complicated to understand and apply. It can be challenging to gain a further understanding of the intricacies of Centers for Medicare & Medicaid Services (CMS) guidance as well as coding technology, artificial intelligence, reimbursement methodology, and general processes and procedures to maintain compliance and avoid the many opportunities for violation.¹

To combat challenges and drive coding uniformity and proper claim submission, the ICD-10 coding guidelines provide a framework for application to ensure that appropriate code capture occurs, in this age of specificity, to the highest possible level of clarification. One can almost feel, see, and experience the medical diagnosis from the medical record documentation as if it were their own. With a surplus of information available at the click of a button, it’s easy to wonder how an organization could end up with claim rejections, claim denials, upcoding, unbundling, inadequate application of coding guidelines, compliance issues, and lack of clarification to name a few common mistakes that medical coders and healthcare professionals make day in and day out. Common pitfalls can be avoided through awareness of industry rules and regulations, effective communication, and a robust compliance plan.

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