I know if claims are not coded properly, I might be accused of fraud. What kinds of coding mistakes are most commonly made on claims?

You are correct that you are responsible for the codes you claim. Wrong codes send signals to insurers and could cause them to investigate for fraud or abuse.

Coding is not intended to be difficult: You match the code to the service provided. However, when the code book does not describe the exact service performed, miscoding — due to interpretation — can occur.

Additional problems can arise when a code is added, modified, or removed. If you do not stay up-to-date on changes, you will find yourself frustrated by insurance denials caused by using codes that no longer exist or have been modified to reflect a different service.

You can avoid many coding problems by tapping into a credible source on coding, such as your national or chiropractic association, and by being wary of “creative coding” seminars. Remember: Regardless of where or how you learned coding, you are responsible for the code you put on a claim — not the source of the coding (mis)information.

The most common coding errors appear in two categories — examination and rehabilitation.

• Exam coding errors. Examination coding errors usually involve the higher codes of 99204 and 99205 for the initial visit, and/or 99214 and 99215 for re-examination.

You must ensure the level of service matches these higher-rated codes. For example: Some doctors routinely use 99205 for an automobile-accident examination, although the actual examination and procedures performed are no different from other introductory examinations.

Their usual justification, “I spent more time with the patient,” is not supported by documentation in the notes.

If you use the higher codes, make sure your documentation and procedures are correctly reflected in the chart, otherwise your defense is very weak.

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