What Happens if a Medical Coder Makes a Mistake?

This was a question that I have come across a few times recently. Basically new coders (or people thinking of becoming a coder) are wondering this. I could see why this would be a concern. Medical coders are held to a very high standard both by ourselves and the industry.

But let's think about this--what happens if a coder makes a mistake?

Let's start by saying--no one is perfect. Every single person who is working now as a coder, has made mistakes at one point or another.

The thing that most companies look for is your average accuracy rate. I don't have an exact number of what all places are, but in my experience (which is radiology coding) a coder had to always have a 95% or above accuracy rate. Different places audited coders at different times. Sometimes it was monthly. Sometimes it's daily. It really depends how the company is set up.

This is the ICD-10-CM Book 2023. Book tabs were added to the side of the book to help the coder code faster.

Another thing to keep in mind too--was it a CPT or ICD-10-CM mistake? Usually a CPT error is counted differently against a coder than an ICD-10-CM error. In other words--it's worse to make a CPT mistake than a ICD-10-CM mistake because there is a more likely chance the claim will be denied because of this. So what happens to the coder? It depends how often you're making mistakes. Everyone makes a mistake once in a while. So if this is a rare occurrence for you--in short--nothing happens. Maybe your manager will let you know about it, but that is it. I think what's important here is how you handle it. I think medical coders by nature are perfectionists. So if we hear we make a mistake...we don't like that and may get defensive about it.

If you're told you made a mistake and truly don't think it was a mistake, you can bring proof (an authoritative source) to your manager and talk about it. Just be careful here--all places are set up differently and managers are different. Sometimes it might be best not to say anything. But if it's really bothering you--yes it's ok to say something. Sometimes auditors make mistakes too 🙂 I'm telling you this as an auditor--there have been times that I marked something as incorrect when it really wasn't. Does that happen often? No. But it has occasionally. I don't mind when coders tell me to recheck something. I've had coders come to me an explain their thought process and use sources. If I can see their point of view--there has absolutely been times when the coder proved me wrong. I don't think that makes me a bad auditor--all it means is that I'm human too 🙂 So in short--everyone in the industry will make mistakes sometimes.

If you're wondering what happens to the actual claim that was coded wrong--Usually a corrected claim will be sent in if it denied because of the error. In my experience the person who originally coded the report is not the same person who does the corrected claim--but it may work different elsewhere.

My whole point in writing this really, is don't let being afraid of making mistakes stop you from pursuing medical coding! It is an awesome field to be in 🙂

Thanks for reading,


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