Coding and Denials: It Comes Down to ‘ABCD’

By Angela Lima BS, CCS, CDIP, CIC, COC, AAPC-Approved Instructor

If you oversee the coding process or directly manage coders, you know how important accurate, defensible coding is. Inaccurate coding leads to claim denials. An increase in claim denials may lead to aggressive audits which may point to problems in your team’s coding quality.

So, how can you provide the best defense for your organization and assure that your team codes cases correctly in order to withstand an audit? Coder training may be your best defense against the increase in denials. It comes down to ABCD:

  • Coding that is Accurate truly reflects the patient’s story as captured by the record. There is clear documentation that supports the code selection.
  • Coding that is ‘By-the-book’ means you are able to show why your coding is correct by quoting the applicable guidelines and rules. Your code selection is not depending on unsupported advice found on the internet or “we always do it this way” justification.
  • Coding that is Complete tells the full story of the patient’s condition and treatment. Finding the information requires knowing what to look for and knowing where in the record it will be.
  • Coding that is Defensible means that when the denial comes, you are able to explain and support your code selection using the conventions, guidelines and reliable sources that govern the code sets.

Denials and audits will come. Payers have strong motivation to deny claims or at least delay when they must be paid. And your appeals will not always prevail as there are other factors besides coding that are considered. But arming your coders with the training they need for the work they do gives your organization the best chance of sending the auditors elsewhere to look for those easy dollars.

 

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Disclaimer: This article is written for educational purposes only. Every reasonable effort has been made to ensure its accuracy and completeness. It is the responsibility of the reader to refer to the definitions, descriptions, conventions, and guidelines specific to each coding classification, as well as relevant laws and regulations when selecting and reporting medical codes.

About the Author

Angela Lima
Angela Lima applies a hands-on approach to her role as the Director of Education for Libman Education. Whether overseeing the work of subject matter experts including nationally recognized coding authorities; challenging instructional designers to deliver content in a way that is both engaging and memorable; or tapping her 25 years’ experience in inpatient, outpatient, and emergency room coding to write coder-friendly courses herself, Angela is responsible for ensuring that our training is accurate, easily accessible, and challenging.

One thought on “Coding and Denials: It Comes Down to ‘ABCD’

  1. Stephanie Marsh - May 19, 2022 at 9:49 pm

    This is a wonderful way to defend our coding. Instead of just telling billing the coding is correct, I can now say its Accurate, By-the-Book, Complete and Defensible! Great article!

    Reply

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