Top 10 Errors in Coding and Billing

By Clarke Newman, OD, FAAO

  1. Not learning the text, the pre-text, and the sub-text instructions from CPT for each and every code billed by the provider and reviewing that knowledge on an annual basis.
  2. Not learning the billing policies for each and every code for each and every carrier for which the doctor is a provider on an annual basis.
  3. Contracting as a provider for insurance plans that do not make financial sense for one’s practice.
  4. Failing to pre-verify patient coverage of medically necessary contact lenses before seeing the patient.
  5. Poor documentation and failing to establish medical necessity based on the ordering, interpretation, and plan modification of tests rationally based on the chief complaint.
  6. Failing to charge for follow-up visits when appropriate and knowing when one can charge for those services.
  7. Using CPT codes for non-covered services that do not meet the text, pre-text, and sub-text meaning of the CPT code.
  8. Failing to provide clear direction, verbally and in writing, to the patient with regard to who is responsible for paying for what.
  9. Failing to have a skilled insurance coordinator on your staff and meeting with him/her on a daily basis.
  10. Failing to have pre-written letters of medical necessity and brochures about medically necessary contact lenses.