Discover the most common ICD-10-CM coding mistakes and how to avoid them. Improve accuracy, compliance, and reimbursement with these proven medical coding tips.
Introduction
ICD-10-CM coding is the backbone of accurate medical billing and documentation. With over 70,000 diagnosis codes, it’s no surprise that errors are common—even among experienced coders. Mistakes in ICD-10-CM not only delay reimbursements but can also lead to compliance issues, claim denials, and inaccurate patient health records.
In this blog, we’ll highlight the most common ICD-10-CM coding mistakes and share practical strategies on how to avoid them.
Why Accuracy in ICD-10-CM Coding Matters
Before diving into errors, let’s understand why accuracy is so critical:
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Reimbursement: Insurance companies rely on ICD-10-CM codes to process claims. Wrong codes = delayed or denied payments.
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Compliance: Coding errors can trigger audits and compliance risks.
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Patient Care: Inaccurate codes affect continuity of care and medical records.
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Data Reporting: Public health organizations use ICD-10-CM data for research and policy-making.
Simply put, coding accuracy keeps the healthcare system running smoothly.
6 Common ICD-10-CM Coding Mistakes
1. Overusing Unspecified Codes
Unspecified codes (like E11.9 – Type 2 diabetes mellitus without complications) are sometimes unavoidable, but excessive use may signal poor documentation. Often, more specific codes are available and required for accurate reimbursement.
👉 How to avoid it: Always check provider documentation carefully. Query the provider if details like complications, location, or severity are missing.
2. Misinterpreting Laterality
ICD-10-CM requires coding for laterality (right, left, or bilateral). For example:
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M25.511 – Pain in right shoulder
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M25.512 – Pain in left shoulder
Using the wrong side leads to claim rejections.
👉 How to avoid it: Double-check the documentation for laterality. Always confirm if the condition affects one side or both.
3. Missing Combination Codes
Certain conditions must be reported with combination codes. For example, “Hypertension with chronic kidney disease” should be coded with a single combination code, not two separate ones.
👉 How to avoid it: Review ICD-10-CM guidelines for combination codes in conditions like diabetes, hypertension, and pregnancy.
4. Overlooking Sequelae (Late Effects)
A sequela refers to long-term complications of a disease or injury. For example, coding only “stroke” but missing “hemiplegia due to previous stroke” is a common error.
👉 How to avoid it: Look for documentation that describes complications or residual conditions. Always capture sequelae codes when relevant.
5. Confusing ICD-10-CM with CPT/PCS
ICD-10-CM is for diagnosis coding, while CPT and ICD-10-PCS are for procedure coding. Mixing them up is a frequent mistake among new coders.
👉 How to avoid it: Remember: ICD-10-CM = diagnosis codes, CPT/PCS = procedure codes. Keep references handy when coding both.
6. Ignoring Annual Updates
Every year, ICD-10-CM undergoes updates and revisions. Using outdated codes can cause compliance issues and claim denials.
👉 How to avoid it: Always use the latest ICD-10-CM manual or updated coding software. Attend webinars or training sessions to stay informed.
How to Avoid ICD-10-CM Coding Mistakes
Now that you know the common errors, here are best practices for avoiding them:
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✅ Stay Educated: Attend workshops, webinars, and refresher courses.
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✅ Use Updated Resources: Never code from outdated manuals.
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✅ Query Providers: Ask for clarification when documentation is unclear.
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✅ Leverage Technology: Use coding software with built-in error alerts.
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✅ Conduct Regular Audits: Review coding accuracy to catch repeat mistakes.
Case Example: Diabetes Coding Error
❌ Incorrect Code: E11.9 – Type 2 diabetes mellitus without complications
✔️ Correct Code: E11.65 – Type 2 diabetes mellitus with hyperglycemia
Why? Documentation showed the patient had uncontrolled diabetes with hyperglycemia. Using an unspecified code would underreport the severity and affect reimbursement.
Conclusion
ICD-10-CM coding mistakes are common, but with proper training and attention to detail, they can be avoided. Accurate coding ensures faster reimbursements, better compliance, and improved patient care.
By recognizing the most frequent mistakes—like overusing unspecified codes, missing laterality, and ignoring updates—you can code with confidence and accuracy.
❓ Frequently Asked Questions About ICD-10-CM Coding Mistakes
1. What are the most common ICD-10-CM coding mistakes?
Some of the most frequent ICD-10-CM errors include overusing unspecified codes, misinterpreting laterality (left vs. right), missing combination codes, overlooking sequelae, confusing ICD-10-CM with CPT/PCS, and failing to use updated codes.
2. Why is accuracy important in ICD-10-CM coding?
Accurate ICD-10-CM coding is essential for correct reimbursement, compliance with regulations, and maintaining precise patient health records. Errors can lead to claim denials, audits, and even legal risks for healthcare providers.
3. How can coders avoid ICD-10-CM mistakes?
Coders can avoid mistakes by using the latest ICD-10-CM manual or coding software, attending ongoing training, clarifying unclear documentation with providers, double-checking for specificity (like laterality), and conducting regular internal audits.
4. What happens if the wrong ICD-10-CM code is used?
Using the wrong ICD-10-CM code can result in denied insurance claims, delayed payments, compliance penalties, and inaccurate patient data. It may also impact healthcare reporting and research.
5. How often are ICD-10-CM codes updated?
ICD-10-CM codes are updated annually, usually in October. Staying current with updates is critical for accurate coding and avoiding claim rejections.
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