If you oversee the coding process or directly manage coders, you know how important accurate, defensible coding is. Inaccurate coding leads to claim denials. An increase in claim denials may lead to aggressive audits which may point to problems in your team’s coding quality.

So, how can you provide the best defense for your organization and assure that your team codes cases correctly in order to withstand an audit? Coder training may be your best defense against the increase in denials. It comes down to ABCD:

Coding that is Accurate truly reflects the patient’s story as captured by the record. There is clear documentation that supports the code selection.

Coding that is ‘By-the-book’ means you are able to show why your coding is correct by quoting the applicable guidelines and rules. Your code selection is not depending on unsupported advice found on the internet or “we always do it this way” justification.

Coding that is Complete tells the full story of the patient’s condition and treatment. Finding the information requires knowing what to look for and knowing where in the record it will be.

Coding that is Defensible means that when the denial comes, you are able to explain and support your code selection using the conventions, guidelines and reliable sources that govern the code sets.

Denials and audits will come. Payers have strong motivation to deny claims or at least delay when they must be paid. And your appeals will not always prevail as there are other factors besides coding that are considered. But arming your coders with the training they need for the work they do gives your organization the best chance of sending the auditors elsewhere to look for those easy dollars.