Are ICD 9 Coding Errors Avoidable?

Medical coding errors can be unavoidable at times, if information is lacking or incorrect before ICD 9 codes are applied during the medical billing process. However there are different ways that you can decrease the amount of billing errors associated with incorrect ICD 9 codes, therefore avoiding the disasters that can happen if incorrect ICD 9 codes are billed to the health insurance company.

What are ICD 9 Codes?

ICD 9 codes are a system of numbers that were created to help health insurance companies identify patient diagnosis’ through numbers rather than words, being that doctor’s handwriting is known for its illegibility.  Medical claims are sent by doctor’s offices with these ICD 9 codes, along with procedure codes known as CPT codes, and the amount billed for the services rendered. The health insurance companies then use these numbers to evaluate the claim, determine medical necessity, and pay out their approved amount for the services rendered.

Avoiding Errors with ICD 9 Codes

To avoid ICD 9 coding errors there are certain steps that can be taken to ensure medical billing success in any medical facility that might need to send medical claims out, whether for a physician’s office, durable medical equipment company, or pharmacy. As a medical biller for a durable medical equipment company I learned the hard way that information can very easily be entered into the medical billing software incorrectly, so it is of the utmost importance to have the patient’s paperwork in front of you before sending the medical billing claim out to the health insurance company, in case there are typing errors within the medical billing software; having the initial written paperwork in front of you allows you the ability to check for diagnosis code typing mistakes.

Another reason to have the written initial paperwork in front of you, as the medical biller, is so you can check for any diagnosis code contradictions in the medical billing software, and the actual written out diagnosis on the patient  intake form. It is very common for the medical assistant, case manager, or referred physician to read the prescription from the ordering physician incorrectly, which would cause an incorrect diagnosis code to be input into the medical billing software. As a medical biller catching those types of errors can mean the difference between the patient’s claim getting paid by the health insurance company or not.

Comparing CPT codes with ICD 9 codes are a great way to avoid coding errors. Working for a medical equipment company, I did not use CPT codes, but we did use HCPCS codes, which were codes used to identify the durable medical equipment ordered for the patient. Comparing HCPCS codes with ICD 9 codes would allow me to catch any diagnosis codes that may not have made sense when associating it with the durable medical equipment the patient was to receive; for example, someone receiving a walker should not have a diagnosis code for a broken finger; this would be a red flag for me to check the accuracy of the diagnosis code entered into the medical billing software. The same concept applies for CPT codes and ICD 9 codes; a doctor would not perform a procedure on a finger for a diagnosis of a broken foot.

Using Correct ICD 9 Codes

Correctly coding a diagnosis is crucial for any healthcare or pharmaceutical facility. If the ICD 9 code being billed for is incorrect, it not only effects the patient, but it can also effect the facility as well. If a patient receives a bill that should be covered and the health insurance company informs them that their healthcare facility did not bill for the correct ICD 9 codes, the patient will not only go after the careless physician’s office, pharmacy, or durable medical equipment company for their inadequate and unlearned medical billing staff, but they will also take their business elsewhere, no matter how good the service initially was; no one has the money or time to waste on a company that does not even take the time to ensure their covered services are billed properly, in order for their business to get paid, and their patient’s to have a sense of reassurance that they have completely taken care of all of their needs.