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Prevent Medical Coding Fraud and Abuse Claims Before They Happen

Posted by David Fong on Aug 30, 2018 5:30:00 AM

According to the AMA’s Principles of CPT® Coding, ninth edition, as reported in the AMA Wire® newsletter, when it comes to medical coding errors, they fall into the broad categories of “fraud” and “abuse.” The former involves intentional misrepresentation. The latter means “the falsification was an innocent mistake, but nonetheless representative,” An example of abuse could involve coding “for a more complex service than was performed due to a misunderstanding of the coding system.”

 content-mistakes-Here are some of the most common mix-ups/errors to avoid in medical coding:


  • Unbundling codes
  • Upcoding
  • Failing to check National Correct Coding Initiative (NCCI) edits when reporting multiple codes
  • Failing to append the appropriate modifiers, or appending inappropriate modifiers
  • Overusing modifier 22–increased procedural services. You must include proper documentation to explain why the procedure requires more work than usual
  • Improper reporting of the infusion and hydration codes, which are time-based
  • Improper reporting of injection codes
  • Reporting unlisted codes without documentation.


Aviacode’s Coding Services can help you avoid these coding errors with advanced medical coding solutions that guarantee accuracy and turnaround; they are also less costly and less hassle for practice managers, physicians, hospitals, health systems, providers and payers.


Aviacode uses over 600 of the best credentialed and experienced coders in the industry. All our coders are AAPC or AHIMA – certified, experienced, and specialty focused. They are continually working to improve their productivity and to stay on top of changes in rules and regulations through ongoing training.  Aviacode contractually guarantees our coding service accuracy to give you peace of mind.

Aviacode has skilled coding expertise in a number of chart types, including inpatient, outpatient, same-day surgery, emergency department, observation, ancillary, recurring, and diagnostic and interventional radiology. Our coders and auditors have deep experience from facility, pro-fee, and HCC / risk adjustment.


To further ensure your compliance and accuracy, we offer our Coding Compliance & Audit Services that provide a comprehensive accuracy review of your current coding process, and will identify errors and help prevent future coding-related denials.


Let Aviacode help you avoid fraud and abuse claims before they happen!

Topics: Medical Coding, Medical Coding Audits, Outsourcing