4 Medical Coding Errors That Allergy Clinics Should Avoid This Spring!

Spring is officially in the air, which means that temperatures are on the rise—as well as seasonal allergies. As pollen begins to infiltrate outdoor air quality, it’s crucial for allergy clinics to be prepared for an influx of patients.

If you manage an allergy clinic, then you likely already know just how much medical coding impacts both your patient care and overall revenue. Even the slightest coding error can lead to rejected or denied claims, which is why claims adjudication processes often come back to errors made by professional medical coders.

At Millenium Medical Billing, we prioritize flawless medical coding for all of our clients, and below we’ll be detailing some of the common allergy-specific coding mistakes that clinics need to avoid this spring!

How Exactly Does Medical Coding Impact a Clinic’s Revenue?

Medical coding is an incredibly complex task, and it involves collecting a physician’s technical notes/information and converting this data into alphanumeric codes. Coding is considered to be a more efficient type of medical documentation because this format is standardized throughout the industry, and there’s no denying just how vital coding is for the entire medical billing process.

Comprehensive medical coding ensures that clinics receive accurate and timely payments, and improper coding often results in significant financial setbacks. This is why healthcare professionals must always team up with detail-oriented, thorough medical coding professionals—and outsourcing your coding tasks to the Millenium team keeps your practice running smoothly!

Common Medical Coding Errors

Coding issues often lead to billing mishaps, which delays payments, leads to claim denials, and can even create legal problems for healthcare teams.

Some of the most common medical coding errors that need to be avoided include:

1. Upcoding

This is technically a form of healthcare fraud that involves a provider billing a patient for more expensive services than they actually received. It can sometimes involve the purposeful or accidental manipulation of CurrentProcedural Terminology (CPT) codes.  

What’s often the case is that a healthcare provider doesn’t quite realize that they’re upcoding their patients, or that their documentation is lacking in one way or another.

2. Undercoding

Undercoding entails medical bills not representing the full extent of a patient’s procedure, which subsequently leads to financial losses for healthcare providers.

This dilemma can be solely sourced back to undercoding errors, and it can also involve missing medical record information.

3. Inappropriate Modifier Usage

Medical coding modifiers typically indicate things like multi-provider procedures, additional work or unusual tasks. Incorrect modifier usage typically results in a denied claim when it inaccurately reflects the provided services.

4. Incorrect or Unlisted Code Usage

There are plenty of complex procedures that can confuse medical coders while they’re selecting CPT codes. Making this type of error will lead to billing mishaps, and can jeopardize reimbursement accuracy.

5. Mismatched ICD & CPT Codes

It’s also common for clinics to mismatch diagnosis (ICD) and treatment (CPT) codes. This error can lead to claim denials and payment delays.

Allergy-Specific Medical Coding Errors To Be On The Lookout For This Spring!

A lot of clinics experience an increase in patient visits and medical coding workload during peak allergy seasons, which is why there are certain allergy-specific medical coding errors that impact healthcare teams this time of year.

Some of the most common coding errors at allergy clinics include:

1. Overlooking J30 (Allergic Rhinitis & Vasometer) Codes

It’s typically best for clinics to avoid using the J30.1 code for pollen-induced allergies and allergic rhinitis.

It’s better to more thoroughly understand a patient’s symptoms, and subsequently choose a more specific code. This includes codes like J30.81 for rhinitis caused by animal dander or hair, or J30.5 for food-induced rhinitis.

The more specific you are with your medical coding, the more accurate your reimbursements will ultimately be.

2. Selecting Incorrect Immunotherapy Injection Codes

Many healthcare providers think they should just add additional 95115 code units when billing for multiple injections, but this is a huge error that’ll lead to underpayments and claim denials.

It’s important to remember that code 95115 is only used for a single injection, and that CPT code 95117 is correct for multiple injections. This code is applicable for any number of various injections, but it’s supposed to be billed as one unit.

3. Reporting an Allergy Testing E/M Code

A lot of physicians will make the mistake of adding on an E/M (evaluation and management) code when they’re conducting allergy testing. Allergy tests utilize codes like 95004, and this includes test reporting and interpretation.

Although these tests overlap with E/M code components, the claim will typically be denied when these codes are billed together. In order for an E/M to be billable on the same day as an allergy test, the reasoning for the testing would have to be fully unrelated to the allergy testing. This would also require an appeal and detailed documentation to be paid.

4. Underreporting Immunotherapy Units

Using the 95165 code for immunotherapy billing is often tricky, and this is particularly because healthcare providers must be extra careful about billing for proper antigen units.

Billing for antigen and dilutions vary by state and payer, and it’s crucial to ensure that all serum limits are accounted for and fully reimbursed. Avoiding any underreporting may seem simple, but it’s an incredibly important part of maximizing your clinic’s revenue and billing accuracy.

Millenium Medical Billing Takes The Coding Load Off Your Shoulders!

Avoid the common allergy clinic pitfalls listed in the above sections and secure your insurance reimbursements with the help of our acclaimed medical billing specialists!

Millenium Medical Billing is a trusted medical billing provider that’s supported healthcare professionals throughout the country for over 15 years, and we pride ourselves on providing customized services for each of our clients.

So if your allergy clinic is getting prepped and ready for an inevitable influx of patients this spring, reach out to us online or call us at 718-356-1337 to put your medical coding strategies on the right track toward successfully supporting your revenue!