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Costly medical coding mistakes to avoid at all cost

On Behalf of | Feb 20, 2024 | Compliance

From obtaining a medical degree to finding an appropriate facility, getting the practice licenses and hiring the right team, a lot goes into setting up a medical practice. If you’ve put in so much, you want to be sure that everything, from receiving and treating patients to billing and discharging, runs smoothly. 

Unfortunately, mistakes happen. Failing to understand medical billing and coding guidelines can impact your practice and lead to costly penalties that can run into thousands of dollars. Obviously, you do not want this to happen. 

Here are two costly medical coding mistakes that you should steer clear of as much as you can:


Unbundling happens when the practice uses multiple Current Procedural Terminology (CPT) codes for the individual components of the procedure. This can happen when the provider does not understand what they are doing or when they are intentionally attempting to overcharge the patient. Per the existing billing guidelines, you cannot break down a service into various components and code and bill each component independently. 


Upcoding happens when the healthcare provider submits more expensive or more complex diagnoses codes to the insurance company, Medicare or Medicaid to claim a higher reimbursement than they are entitled to. Common examples of upcoding are when the healthcare provider follows up on an inpatient consultation but bills using a higher-level E&M code as if they were providing consultation to a new patient.

Protecting your practice

Whether intentional or otherwise, medical coding mistakes can expose your practice to serious financial and reputational losses. Depending on the severity of the mistake, your practice may be permanently banned from participating in Medicaid and Medicare. Find out how proper legal guidance can help you protect your practice’s interests if you are under investigation for medical coding malpractice.