Pulmonology Coding Alert

Question: We recently performed a self-audit and found that there are certain issues that our staff members have repeatedly that they don’t seem to ever stop making. For instance, one coder always reports the office place of service, even when encounters take place in the hospital. And one physician always confuses modifiers 24 and 25. Is there a workaround for this?

Idaho Subscriber

Answer: There isn’t a specific workaround, but you’ve already performed an important step in fixing the problem, and that’s your self-audit. If you checked your records for common errors and found a few to list, create a “Most Wanted” list and distribute it throughout the practice. Items like incorrectly listing a place of service, leaving off a modifier, or not matching the diagnosis code with the procedure performed can prompt a denial needlessly, and everyone in the practice should be aware of when they’re making these types of mistakes, as well as how they can stop.

If you performed a retrospective audit, meaning you already billed these claims, it’s possible you may have found denials due to these issues. You can always correct claims that had errors on them and resubmit them, or appeal if you feel like you had claims denied wrongly. Any appeals should include a very personalized, directed, appeal letter. In addition to quoting from the CPT^® and insurance guidelines in the documentation, personalize your appeals, ensuring that the physician describes in their own words exactly what took place during the procedure, and pinpoint the appropriate source who should receive the appeal letter.