This is an important misstep to avoid! Using incorrect codes and ignoring important annual code changes could cost your urgent care valuable reimbursements.
Misstep 4: Using Wrong Codes and Ignoring Code Changes
Providers tend to get comfortable with their E/M code selection. Choosing a “just-right” Level 2 or 3 code is seen as a more prudent coding choice than choosing higher level codes—even if documentation supports a higher code level. If providers consistently select lower code levels than services performed, your practice could be losing hundreds of dollars a day.
Incorrect or incomplete documentation habits lead to poor coding, both under-coding and up-coding (which often initiates audits). Providers will regularly focus directly on patient care, leaving code selection entirely in the hands of the coder. While not incorrect in their focus, this mindset can contribute to loss of revenue and incomplete documentation.
The American Medical Association
updates CPT codes annually; and the U.S. health system is transitioning from ICD-9 to ICD-10 (adding thousands of codes which will impact practices and payers). If your coding team isn’t upon code changes and isn’t re-certifying for updates—your claims could be submitted with dated info, and you could be losing money.
Advice: Audit claim levels in your practice over several years and compare them to the industry norm. See if you’re potentially under- or up-coding based on benchmark patterns. If using an EHR, see if providers regularly select a code other than what the system suggests or are selecting a single code level frequently. Make sure your coders are up to date on code changes.
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