A Look At The Most Common Medical Bill Coding Errors

Paying medical bills is a huge hassle and expense for companies. With the cost of providing workers compensation coverage for employees rising, it's more important than ever that employers have a cost control process in place to minimize expenses and maximize savings.

Paying medical bills is a huge hassle and expense for companies. With the cost of providing workers compensation coverage for employees rising, it’s more important than ever that employers have a cost control process in place to minimize expenses and maximize savings. One important aspect of any cost control plan is medical bill reviewing.

The medical billing process is confusing. Every service that a hospital or doctor renders has a specific billing code assigned to it. Then, depending on the circumstances under which the service was rendered, billing modifiers may need to be used to adjust the final charges billed to the payer. Unfortunately, billing departments often misuse modifiers – usually accidentally but in some cases in an effort to get more money unfairly out of payers – and this leads to overcharging the payer. It’s important that employers are able to catch these billing mistakes, challenge them, and get them corrected.

With that in mind, let’s take a look at some of the most common medical bill coding mistakes:

Modifier -50 – Modifier -50 is supposed to be used whenever a bilateral procedure is performed during the same operative session. With Modifier -50, the payer is supposed to be responsible for only 150% of the allowable charge (100% of the allowable charge for the first side, 50% for the second side). However, this modifier shouldn’t be used on procedures that are inherently defined as bilateral. In such instances, use of Modifier -50 would lead to excessive charges.
Modifier -51 – When multiple medical procedures commonly performed together are provided during the same session or on the same day, Modifier -51 is used to let the payer know that two or more procedures are being reported during the same day. This provides the payer with a discounted rate on the additional services. However, this modifier is often not used when it should be, or it gets confused with Modifier -59, leading to unfair, excessive charges.
Modifier -59 – Like Modifier-51, Modifier -59 involves multiple procedures. However, what makes Modifier -59 different is that it’s used when multiple, distinct (or independent) services are performed. Distinct is the key word to pay attention to in this case.
Modifier -62 – When two surgeons work together to perform distinct parts of the same overall procedure, Modifier -62 is supposed to be applied, meaning each surgeon should be billing at 62.5% of his/her fee schedule. This should not be used if the co-surgeon is acting as an assistant during additional procedures, and it should not be used with Modifier -80 on the same CPT code for a co-surgery.
Modifiers -80/-81/-82/-AS – This group of modifiers falls under the category of “assistant at surgery.” Understanding which modifier should be used in which situation is essential to accurate billing. Modifier -80 is to be used when the individual providing the assistance at surgery service is an MD. Modifier -81 is to be used when the individual providing the assistance at surgery service is a RN/CSA/. Modifier -82 should be applied when the person providing the assistance at surgery service is an MD and there wasn’t a qualified resident surgeon available. Finally, Modifier -AS is used when the assistant at surgery is a PA, NP, or clinical nurse specialist.
Anesthesia Modifiers – Whenever anesthesia is administered, it’s billed using specific modifiers. Proper use of these modifiers is important to accurate billing. Modifier -AA is used when an MD provides the anesthesia service independently. Modifier -QZ should be used when a CRNA performs the anesthesia service independently. -QK should be applied when an MD oversees two to four concurrent anesthesia procedures.

And Modifier -QX is used when a CRNA performs the anesthesia service with an MD supervising.

With so many intricacies in medical bill coding, your best bet is to partner with a medical bill auditing company. Medical bill auditors will carefully review every charge on every bill you receive to verify accuracy. When mistakes are spotted, they are challenged and corrected accordingly to save you money. It’s the best way to avoid excessive billing for employers, and it’s an integral part of any cost control plan.

Chris Drevalas is the Vice President of Marketing & Finance at Alpha Review Corporation. He has helped companies of all types with their workers compensation issues for the past ten years. www.alphareview.com