Medical Coding Mistakes Happen - But How Often?

by  Find-A-Code™
Jan 12th, 2023

Nobody is perfect. Workers in every industry make mistakes. Even medical coders and billers sometimes get it wrong. But in the medical insurance game, it seems like mistakes are harder to identify and even harder to rectify. One recent case out of Illinois shows that medical coding mistakes do happen. But the case raises the question of how often such mistakes occur.

The case involved a Chicago doctor who was sent a bill after being treated for a broken arm. The bill seemed excessively high to his medical biller wife. A year's worth of back-and-forth with the hospital and insurance company revealed that the doctor had been billed for a procedure that was never performed.

A Complex Enterprise

It is no secret that medical billing is a complex enterprise. That is one of the reasons organizations like Find-a-Code exist. We help medical coders by providing easy access to accurate and updated codes so that they don't spend so much time thumbing through printed manuals. But even with easy, online medical code look-up, mistakes can happen.

Medical coders are a bridge between clinicians and medical billers. It is their responsibility to take the information recorded by clinicians during a visit and translate it into standardized codes that billers then apply to the invoices they create. A mistake at any point in the process can lead to erroneous bills being sent to payers.

The Chicago Case

A single coding mistake is purportedly behind the Chicago case. As reported by Kaiser Health News, 47-year-old Dr. Bhavin Shah broke his arm while skiing with his family in Wisconsin. The total cost of his ER treatment came in at a whopping $10,563, of which he was responsible for paying just over $3,300. Dr. Shah just assumed the bill was accurate.

His wife, who is the primary medical biller for his practice, did not agree. She set out on a year-long journey to find out what was going on and rectify the situation – even though the couple could afford to pay their portion of the bill without issue.

To make a long story short, Sunita Kalsariya contacted the hospital and insurance company on her husband's behalf. She investigated the cost of her husband's treatment at other hospitals. She even filed a complaint with the Illinois Attorney General's office.

When all was said and done, an itemized bill revealed an incorrect medical code. Apparently, Shah was billed for a treatment rather than just the splint he received. The hospital that treated him offered no explanation for the coding mistake. However, it did correct the bill. Shah ended up paying just over $1,200 based on his plan's deductible and additional charges.

It Helps to Pay Attention

Shah's experience demonstrates that mistakes do happen. Medical coders do their utmost to make sure their work is accurate. The same goes for clinicians and medical billers. But there are far too many moving parts in medical coding and billing to guarantee accuracy 100% of the time. What does this mean for consumers? That it helps to pay attention.

There are legal means through which patients can contest their bills. Thanks to federal law, patients can also look up and compare prices for healthcare services offered through different providers. Should disputed medical bills go to collection, patients even have a right to demand that collection agencies be informed of the dispute so that the collection doesn't harm their credit reports.

Unfortunately, the complexity of medical coding and billing is such that mistakes are inevitable. The question is not one of if they occur, but how often they occur. That would certainly be worth knowing.