Guide 6: Different Types of Coding Errors (and How BillCare Prevents Them)

Medical coding is how clinical care gets translated into reimbursement. But when codes go wrong, so does the revenue. Inaccurate coding can lead to claim denials, delayed payments, compliance issues, and even fraud investigations. That’s why catching errors early is essential.

In this guide, we’ll walk through the most common types of coding errors, explain their impact, and show how BillCare's tech + team help your practice stay error-free.

1. ❌ Incorrect Code Selection

This happens when the code doesn’t accurately reflect the service or diagnosis:

• Using a generic or outdated code

• Choosing the wrong CPT level (e.g., level 5 visit when it was level 3)

• Misclassifying the diagnosis or procedure

🔍 Real-world impact:

Over coding = audits and penalties.

Under coding = revenue loss.

Both = payer distrust.

💡 BillCare prevents it:

Our AI and certified coders cross-check every code against visit notes and payer rules, so you're always billing accurately.

2. 🧩 Missing or Incomplete Codes

When a code or modifier is left out:

• Forgetting a modifier (like -25 or -59)

• Skipping secondary diagnoses that justify the visit

• Leaving out HCPCS codes for supplies provided

🔍 Real-world impact:

Claims get denied or underpaid. Payers ask for extra documentation. Patients get confusing bills.

💡 BillCare prevents it:

We run completeness checks before submission—no missing codes, no missed revenue.

3. 🔁 Duplicate Coding

When the same code is entered twice for the same service date:

• Billing for a service already included in another code

• Accidentally submitting the same claim twice

🔍 Real-world impact:

Immediate rejections or allegations of fraud.

💡 BillCare prevents it:

Our system flags potential duplicates before claims go out. If a service is bundled, we know not to bill it separately.

4. 🧮 Upcoding & Downcoding

This refers to coding a service at a higher or lower level than what was provided:

• Upcoding: billing for more complex care than delivered

• Downcoding: playing it safe with lower codes to avoid denials (and leaving money on the table)

🔍 Real-world impact:

Upcoding = audit risk and legal exposure

Downcoding = chronic underpayment

💡 BillCare prevents it:

We ensure documentation matches coding. If a provider consistently over- or under-codes, we alert and train them.

5. 🧾 Unbundling

Billing each component of a bundled procedure separately:

• Example: Billing for anaesthesia, surgical prep, and surgery individually instead of using the bundled code

🔍 Real-world impact:

Flagged as noncompliant or fraudulent. Payers reject and investigate.

💡 BillCare prevents it:

We follow NCCI (National Correct Coding Initiative) edits and payer-specific bundling rules.

6. 📅 Wrong Date or Provider Info

Even when the codes are right, mismatches in service dates, provider NPIs, or place of service can derail a claim.

🔍 Real-world impact:

Denials due to technical mismatches—not medical necessity.

💡 BillCare prevents it:

We auto-populate provider data and validate dates to avoid formatting or credentialing errors.

📌 Summary: Common Coding Errors vs. BillCare Prevention

❤️ BillCare = Coding Confidence

When coding is wrong, everything downstream breaks. With BillCare, your practice gets:

• ✅ Expert coders on every claim

• ✅ AI audits that never sleep

• ✅ Faster approvals, fewer denials

• ✅ Better revenue and full compliance