Good news – coders are cutting their ICD-10-CM coding error rate from an average of 15% just after the codes took effect in 2015 to 7% last year, attendees learned at this year’s AAPC Healthcon in Las Vegas.
That average is based on a survey of 600,000 audits conducted by Healthicity, a partner organization of AAPC.
As you might expect, coder and provider education and improvements to provider coding software contributed to the error rate’s reduction, explained Jeff Young, AAPC vice president for product development. However, the growing importance of diagnosis codes in physician payment models also may be playing a role, he suggested.
“As we move into value-based, performance-based methodologies, ICD-10-CM codes become much more important,” Young explained.
In a presentation on audit and compliance trends, Young described some of the most common coding errors by specialty as well as by state. Practices can examine their own coding records for these codes to see how they compare and whether further education is needed:
Specialties where the most errors are seen: Family practice and internal medicine. This is not surprising “due to the scope of codes they have to use,” Young observed.
Top error codes: Z00.00 (Encounter for general adult medical examination without abnormal findings), E11.65 (Type 2 diabetes mellitus with hyperglycemia) and M25.569 (Pain in unspecified knee).
Some top ICD-10-CM coding errors by state, which Young said was based on practices’ internal audits:
- Idaho, Michigan, Montana and Ohio: E78.5 (Hyperlipidemia, unspecified),
- Kentucky and North Carolina: Z00.00 and
- Florida: F41.9 (Anxiety disorder, unspecified).
Of CPT coding errors, only 29% involved E/M codes, Young said. Geographically, he said it appears practices in certain states have problems with physicians intentionally downcoding their services, while others may have the opposite problem.
For example, there were more coding errors involving a level 3 established office visit (99213) in California, Iowa, Maryland, Michigan and New York. In Florida, North Carolina, South Carolina and Texas, by contrast, auditors found the most errors with level 4 established office visits, 99214.