Medical Billing Coding Errors: Are Incorrect CPT and ICD-10 Codes Costing Your Practice Revenue?

Last week, we talked about how something as small as incorrect patient information can create a much bigger revenue problem.

But what happens when all the patient information is correct, the claim is submitted and it still doesn't get paid?

Sometimes, the problem is hiding in the codes.

Medical Billing Codes Don't Stand Still

CPT and ICD-10 codes change.

Codes are added, revised, and deleted. Guidelines change. Payer requirements can vary. And documentation still has to support what's being billed.

Keeping up isn't something you do once and check off the list.

It requires ongoing attention.

And in a busy medical practice, that responsibility may be sitting with someone who already has a very full plate.

That's where problems can begin.

An outdated code, incorrect code selection, or mismatch between the documentation and what was billed can result in a rejected or denied claim.

Then the work starts all over again.

Someone has to identify the problem, review the claim, make the correction, resubmit it, and follow it until payment is received.

One coding mistake doesn't just delay revenue. It creates more work for a team that may already be struggling to keep up.

“Just Keep Up With the Changes” Isn't Much of a Strategy

It's easy to say that whoever handles coding should stay current.

Of course they should.

But we also need to be realistic about what we're asking people to do.

If the person responsible for coding is also handling billing, posting payments, working denials, answering patient questions, following up on A/R, or managing other administrative responsibilities, when exactly are they supposed to research changes and stay current?

That's an important question. Because once again, what looks like an employee mistake may actually point to something bigger.

Is this a knowledge problem or a capacity problem?

Maybe it's both.

The Cost Goes Beyond One Denied Claim

The financial impact of incorrect coding isn't limited to a single delayed payment.

Repeated coding problems can create unnecessary denials, slow reimbursement, increase staff workload, and make it harder to understand what's really happening inside your revenue cycle.

And simply correcting each claim as the problem appears doesn't address the bigger issue.

If the same type of coding problem continues to happen, it's worth asking:

Why?

Is additional education needed?

Is there a documentation issue?

Is there a breakdown between the clinical and billing sides of the practice?

Does the workflow need to change?

Or does this responsibility require more dedicated expertise than your current team realistically has available?

That's a very different conversation from simply telling someone to “be more careful.”

Being Capable Doesn't Always Mean It Should Stay on Their Plate

A good employee can be capable of handling a responsibility and still not be the best person to continue carrying it.

That's especially true when the responsibility requires specialized knowledge and ongoing attention.

At some point, practice leadership has to look beyond whether someone can do the work and ask:

Is this still the best use of their time?

Sometimes the answer is better training.

Sometimes it's a stronger internal process.

Sometimes technology can help.

And sometimes specialized outside support can give your practice access to the expertise it needs while allowing your existing team to focus on the responsibilities where they create the most value.

The answer won't be the same for every practice.

But ignoring the question can become expensive.

Look Beyond the Coding Error

When you discover an incorrect or outdated code, fix the claim.

But don't stop there.

Ask why it happened.

Because correcting one claim may recover one payment.

Correcting the process that allowed the mistake to happen can protect the revenue that comes after it.

And if your team is already stretched thin, adding “keep up with every coding change” to an overflowing list of responsibilities may not be a sustainable solution.

Your team doesn't need another responsibility. They may need someone to share the load. It’s time to have a conversation, email us at info@dresdenmed.com.