8 Experts Share the Worst Medical Coding Advice

KIWI-TEK asked medical coding and HIM experts to share the worst coding guidance they ever received. Here’s the worst advice and what they had to say about it.

“Coders should assign whatever is documented by the provider, without concern as to whether it meets clinical criteria.” We as coders are better than that. We should be touting our skills and abilities to review for clinical indicators.

Director, Auditing Services | 28 years experience

2. “Always add the modifier when you get a PTP edit because the bill won’t go out the door without the modifier.” Why is that the worst advice? Because instead of just throwing a modifier on a CPT code because I got an edit, I did my research and found that modifiers are not meant to “bypass edits just to get the bill out the door” and documentation in the medical record has to support the use of the modifier. Otherwise, we could be billing fraudulently.

RN SNF CDI/Coder | 10 years experience

“Because that’s the way we’ve always done it” is usually not a good strategy. Take time to check the latest references and resource materials before succumbing to this advice. Things change. And with ICD-10, they change quickly.

Small Business Owner | 10 years experience

“To code from the prior month, just copy and paste the same codes for last month on recurring accounts.” I did not adhere to this advice because I knew it was not the proper way to code.

Remote Contract Coder | 26 years experience

“Ignore orders and results.” This is noncompliant coding. “Code for no-show visits.” This is a waste of time and money.

Director, Coding | 20+ years experience

“Payers downcode, providers upcode—it’s what we do.” This is bad advice because everyone should try to assign the right code.

Administrator, Revenue Cycle | 3 years in current role

“That’s the code the encoder took me to.” [or] “That’s the code the CAC suggested.” Encoders, groupers and CACs are great tools but the coding professional needs to know when to question them.

SVP Auditing Services | 36 years experience

“You do not have to learn to use the book if you have an encoder.” All coding professionals should learn to use the book.

Director, HIM | 40 years experience