4 Medical Coding Mistakes That Your Allergy Practice Should Avoid

If you manage an allergy clinic, you know that medical coding affects not only patient care but also your revenue, so much so that even the slightest medical coding error could result in a denied or rejected claim. 

Therefore, a significant part of claims adjudication lies in the hands of your medical coders.

Let's explore why prioritizing flawless medical coding is essential for a smooth practice and the heaps of benefits this brings.

How Does Medical Coding Affect Your Revenue?

Medical coding is a hefty task. It involves collecting information from the physician's notes about diseases, injuries, and medical services and converting it into alphanumeric codes. 

Since codes are short and standardized, this format is more efficient for medical documentation. They serve as references for a patient’s symptoms and diagnosis throughout their care journey and medical histories. 

The process also plays a vital role in medical billing. A comprehensive record of codes ensures that physicians receive timely and accurate payments. Improper medical coding may result in not being paid for the services rendered and cause a financial setback.

With such a risk on the line, medical coding requires experienced professionals who are thorough, patient, and detail-oriented. Having a dedicated medical coder, or even a team of medical coders, means you can be confident that your bottom line is secured and your practice runs without a hitch.

Common Medical Coding Mistakes

Coding errors can lead to billing problems, resulting in delayed payments, denials, or even legal issues. Proper coding ensures that timely billing can take place and that reimbursements are received quickly and accurately. 

Taking note of common medical coding mistakes that practices make might save your practice from worst-case scenarios.

      1.  Upcoding

This is a healthcare fraud tactic where providers bill for more expensive services than those actually rendered, typically involving the manipulation of CPT codes. Often, providers may not even realize that they are coding at a higher level or that their documentation is lacking.

      2.  Undercoding

Undercoding occurs when billed codes do not fully represent the extent of a procedure, causing financial losses for your medical practice. This can be purely due to undercoding, or can be due to missing information in the medical record.

      3. Use of Inappropriate Modifiers

Incorrect use of modifiers, which are usually meant to indicate additional work, multi-provider procedures, or unusual tasks, can result in denied claims if they do not accurately reflect the services provided.

      4.  Use of Unlisted or Incorrect Codes

Confusion in selecting appropriate CPT codes because of procedure complexity results in billing errors and impacts reimbursement accuracy. Be sure to always use the most specific CPT codes.

      5.  Mismatched Codes

Mismatched diagnosis and treatment codes (ICD and CPT) can lead to payment delays or claim denials. This emphasizes the importance of accurate code alignment for successful reimbursement.

Allergy-Specific Coding Mistakes Your Clinic Needs to Look Out For

During peak allergy seasons, patient visits increase your staff's medical coding workload. To help prevent mistakes, here's a brief list of common coding errors in allergy practices.

        1. Overlooking codes in the J30 (Vasomotor and allergic rhinitis) category

Avoid immediately using J30.1 for allergic rhinitis (hay fever) and pollen-induced allergies. Understand your patient's symptoms to choose a more specific code, such as J30.5 for food-induced or J30.81 for rhinitis due to animal hair or dander. The more specific you are, the more accurately your practice can get reimbursed.

        2. Selecting the incorrect codes for immunotherapy injections

Many providers think that when billing for multiple injections and using code 95115, they should just add additional units for each additional shot. This is incorrect and will result in underpayment or outright denial of the claim. Keep in mind that 95115 is used for a single injection only. If multiple injections are given, the correct CPT code is 95117. This code can be used for any number of injections but should always be billed as one unit.

       3. Reporting an E/M code with your allergy testing

Physicians often make the mistake of billing an E/M (evaluation and management) office visit code on the same day as allergy testing. Allergy testing codes, such as 95004, include test interpretation and reporting. These services overlap with the components of an E/M code and will be denied when billed together. In order for an E/M to be paid on the same day, the visit reason would need to be completely unrelated to the allergy testing. Further, this would require detailed documentation and an appeal in order to be paid.

       4. Underreporting your immunotherapy units

Billing for immunotherapy - usually 95165 - can be tricky. When billing for the antigen preparations, providers need to be careful to ensure they bill the proper units. The guidelines for how units for the antigen and dilutions must be billed vary by payer and state. It is also important to watch for monthly and daily serum limits for each payer to ensure that all units of serum are reimbursed. Avoiding underreporting is a simple and effective part of maximizing your billing accuracy and revenue.

Read More: Having Problems Getting Approval With Your CPT Code?

Rest Easy: Remote Coding Takes the Billing Load Off Your Shoulders

Steer clear of these allergy clinic pitfalls to secure those insurance reimbursements! Using the correct code demands precision, accuracy, and a keen attention to detail. But we get it—your patients are your top priority and a major time commitment. That's why tapping into a remote team to relieve tedious medical coding tasks helps you focus on quality patient care while ensuring accurate reports each time.

Unlock your practice's revenue potential with DrCatalyst! Entrust your medical billing and coding to us, and watch your profits soar. We specialize in boosting income for medical practices of all sizes by nailing down the right ICD-11, CPT, E&M, and HCPCS codes. 

Schedule a meeting, and let us show you how to overcome your medical billing challenges and maximize your financial success.