When you visit a doctor, everything they do and all of your medical conditions are coded in a particular way, for billing purposes and for your records. For a variety of reasons, however, sometimes the codes that end up in your records and your treatment don’t always line up correctly. It could be a mistake, your doctor could be using an off-label treatment, or it could even be fraud.
But beyond not matching up with you as the patient, what happens when your medical records are incorrectly coded? There are several possible outcomes, and most spell trouble for someone.
What’s In The Details
Sometimes when medical coders enter information into patient charts, they fail to enter all of the necessary details. This can happen either because the doctors’ notes are insufficient or because of inattention or laziness on the part of the coder. However, if important details are left out of the record, such as the severity of a particular condition, it can result in improper care going forward.
Improper or insufficient medical coding can also prevent doctors from catching other medical mistakes, such as an initial misdiagnosis. For example, a patient experiencing a panic attack might have chest pain, which could be misinterpreted as a potential heart problem by a doctor who fails to fill in all the details. If all the appropriate information were coded for the patient however, the doctor would be able to review that information and reassess the diagnosis.
Another reason that improper coding can cause issues in our larger medical system is because it can interfere with proper payment. In the case of Medicare, doctors are paid based on case outcomes and if a case is incorrectly coded, they may not be appropriately compensated. Unfortunately, since doctors don’t typically do their own coding, they may not initially recognize the error.
Payment problems linked to coding may even be fueling fraud in some cases, as doctors try to increase their income. UnitedHealth was recently charged with overbilling Medicare over several years, contributing to rapidly increasing healthcare costs – and they’re not alone. TeamHealth, a major hospital staff provider, recently settled for $60 million with the Department of Justice regarding their overbilling of Medicare, Medicaid, and other federal agencies.
Finally, improper medical coding can result in long term coverage problems for the patients affected. This can manifest in two primary ways:
First, if a doctor prescribes that a medication or piece of equipment be covered by your insurance, but that prescription doesn’t correspond with your recorded diagnosis, your insurance may not approve it and you’ll have to pay out of pocket. This is beyond the financial means of many patients and can delay or prevent appropriate care.
In other circumstances, improper coding can have an impact on a patient’s ability to get coverage for the rest of their lives. For those with certain conditions, health insurance is more expensive, as they have predictable, high medical costs. In the past, it even excluded people from getting coverage altogether. If your medical records indicate that you have more severe health issues than you in fact have, you may find yourself pursuing coverage, unaware of why your path is blocked.
Medical coding plays an important role at every stage of the treatment process, yet patients are rarely, if ever, aware of the information in their records, and most wouldn’t know how to read that information anyway. It’s vital that we put pressure on medical professionals to prioritize coding and institute checks on the coding process to make sure all details are included and accurate.