Home Health & Fitness Is poor coding killing your medical billing practice?

Is poor coding killing your medical billing practice?

Is poor coding killing your medical billing practice?

Poor medical billing practices can prove to be detrimental to your health practice. Apart from degrading the trust factor among patients and increasing your claim denial percentage, it can also result in legal action against your healthcare practice. You might be surprised to know that medical coding errors are considered both abuse and fraud. 

But it doesn’t matter whether you are doing it intentionally or just because your current workforce lacks the skill and experience required to be good at medical billing, coding errors are fatal to the future of any healthcare service. To avoid falling into the pitfalls of coding errors, many healthcare practitioners prefer to opt for pediatrics billing services. 

But before you start scouring the internet for pediatrics billing services, it is necessary to first understand the most common coding errors that might be proving to be detrimental to your medical practice. 

Unbundling codes

In the case of ideal medical billing, there should always be a single code available to capture payments of the component parts of the procedure. This is what you will get whenever you will choose a pediatrics billing company. But when medical billing is kept in-house with unskilled professionals, unbundling codes becomes a major issue. 

Unbundling refers to using multiple CPT codes for individual parts of the procedure. This is mostly done because of misunderstanding or simply because the people working on medical billing don’t have any idea about this simple practice. In other cases, it is usually done to increase the payment. 


Suppose you are an oncologist and because of the nature of this specialization, you always have to report the highest-level evaluation and management service regardless of the actual condition the patient presents with. This happens mostly because an oncologist deals with highly complex patients only. 

Although this example doesn’t always mean upcoding, one should always be accurate about reporting the level of E/M code based on the condition of the patient, not on the basis of specialty. Upcoding is another reason a pediatrics billing company is called in. 

Not checking NCCI edits

This is another leading cause of coding errors in medical billing. The National Correct Coding Initiative was developed by the Centers for Medicare & Medicaid Services to make sure correct billing methods are used. It is also intended towards reducing the inappropriate payments for all Medicare Part B claims. These are a kind of automated payment edits achieved by analyzing every pair of codes billed for the same patient by the same provider on the same device. 

If there is any type of NCCI edit, one of the codes will be denied. In many cases, a clear guideline is included which states that no modification will be used to override the denial. If NCCI edits look like an alien concept for you and for your administrative department then it is better to look for a pediatrics billing and coding company that can keep at the top of standard medical billing practices. 


Undercoding happens when a patient is not billed for all the treatments and services rendered. Regardless of the nature of the mistake, undercoding can take a toll on medical billing and that’s why, if you can’t find the reason behind it, it is better to work with a pediatrics billing and coding company rather than letting your healthcare facility crumble just because of poor medical billing practice. 

Undercoding is considered a suspicious practice and it might help a patient avoid costly medical bills or it can even help the emergency department avoid audits. It even costs your EM group money. 

Duplicate billing 

This might seem like a no-brainer as even an inexperienced person can spot such silly mistakes. But when you are dealing with hundreds of claims on a daily basis, even the most obvious mistakes might slip your eyes. 

Duplicate billing occurs when the same patient is billed for the same service or procedure, multiple times although the procedure was performed only once or the service was offered only once. 

If you don’t want medical billing to become a perpetrator of your healthcare service, you should either get rid of all the coding errors mentioned in this blog post, or you can simply opt for the professional services of a medical billing company.