The Top Challenges of Medical Coding and How to Overcome Them

Working as a medical coder can be challenging, but it can also be extremely rewarding. In a fast-paced environment that depends on accurate coding, those who work in this industry must be diligent and have a keen eye for detail. This is because mistakes can lead to delayed or even denied claims, which will have a negative impact on a medical facility’s cashflow. So accuracy is vital.

Those who work as medical coders often find that the role does present some common issues, and these make the job harder. Below are just some of the main challenges faced by coders and how these can be overcome.

Missing Information

A patient file or record with missing or incorrect information can lead to a claim being rejected by the insurance company. Even a small mistake, such as a spelling error or a field left blank, can be enough for the claim to be sent back. Each time this happens, it costs the medical facility money, so it is imperative that these mistakes are kept to a minimum. To prevent this from happening, coders should take time to go over each file and to double check that all fields have been completed with no obvious errors.

Insufficient Coverage

Many patients are unaware of what are or are not covered under their healthcare plan. Some don’t realize that their cover has changed and something that they were once covered for no longer applies. This means that a treatment provided might not be covered by the policy and the insurance company will deny the payment. It is important that front-of-house staff speak with the patient at every visit to verify their coverage before treatments are provided.

Changes to Coding Rules

Medical coding changes regularly, with new codes added or removed. Unless medical coders have been kept abreast of the changes with regular training, they might not be aware of the changes. For example, this could mean that they are continuing to use ICD 10 codes after ICD 11 codes have been implemented. The experts at say that coders should avail of ongoing training and stay informed about changes to the coding system.

Lack of Communication

Oftentimes, medical coders find it hard to decipher the information in the files they are translating to code. This might be because the physician has left out vital details or that the writing is hard to understand. The coder should always seek clarification from the physician if they are unsure of anything. It is never appropriate to guess what was meant in order to get the claim sent to the payer quicker.

Missing Authorization

Sometimes, claims are rejected or denied not because of any mistakes made by the staff at the medical facility but because the patient did not seek authorization or referral before getting the treatment. Many healthcare plans require prior authorization from their provider or a referral from a physician before they can access specific services. Without this, the claim might be denied. This could be that the patient simply doesn’t realize they need to have this and because the provider assumes they have already sought authorization. Patients should be informed of their responsibilities before accessing treatment.


Working as a medical coder presents many challenges but most of them can be easily addressed. For example, coders must stay on top of regulation changes to ensure they are always using the correct codes. Staff at the medical facility should be trained to communicate directly with patients to ensure they are aware of their coverage and that they know when to seek authorization for treatments.

Post Author: Frida Anders