CERT Error: Incorrect Coding

When a provider receives a Comprehensive Error Rate Testing (CERT) error for incorrect coding, it means the documentation submitted for review by the provider does not match the codes billed for the claim.

These codes may be ICD-CM, HCPCS, CPT or modifiers. Here are issues that lead to incorrect coding:

1. Incomplete notes
2. Care that was provided but not documented
3. Missing test results
4. Post-operative complications not documented
5. Documentation not completed timely
6. Illegible documentation
7. Inconsistent documentation

Here are some tips to prevent this error:

1. Make sure the date(s) of service are documented
2. Ensure the proper principle diagnosis and principle procedure are coded correctly
3. Include all documentation to support the codes billed
4. Use a checklist to ensure all of the essential pieces are included in the record
5. Make sure that both sides of double sided documents are submitted
6. Remember it is the billing provider’s responsibility to obtain any necessary information required for the record review, regardless of the location of the documentation