Why Medical Coding Mistakes in 2025 Matter
Medical coding mistakes in 2025 continue to be one of the most expensive challenges for healthcare practices. According to the American Medical Association (AMA), small practices lose tens of thousands of dollars annually due to errors that delay payments, cause denials, or increase compliance risks. With new CPT code updates and payer rules, accuracy is no longer optional – it’s essential for financial stability.
1. Misusing E/M Codes Under the 2025 Guidelines
E/M levels now hinge on medical decision-making (MDM) or total time spent. Yet many providers still document using outdated methods.
Mistake: Over-documenting history/exam while neglecting complexity of care.
Solution: Train staff on 2025 rules, use MDM tables, and document exact times for time-based visits.
2. Incorrect Telehealth Coding
Telehealth coding continues to evolve, but payers haven’t aligned. The new 98000–98016 CPT codes cover video and audio visits, but Medicare still requires traditional E/M codes with modifiers.
Mistake: Using incorrect telehealth codes or forgetting modifiers 95 (video) and 93 (audio).
Solution: Always verify payer policy and document visit type clearly.
3. Modifier Misuse
Modifiers are vital but often misused.
Mistake: Overusing modifier 25 or incorrectly applying modifier 59.
Solution: Apply only when documentation supports it, and conduct quarterly modifier audits.
4. Pediatric Vaccine Coding Errors
Vaccine coding challenges remain common in pediatrics and family medicine.
Mistake: Incorrectly using administration codes (90460–90474) or failing to document counseling.
Solution: Use counseling codes for under-18 visits with provider counseling, and non-counseling codes otherwise. Always pair product and administration codes.
5. Prolonged Service Coding Confusion
Prolonged services remain a common trap for providers.
Mistake: Choosing the wrong prolonged service code or miscounting thresholds.
Solution: Use +99417 (commercial) or +G2212 (Medicare) for office visits. Document exact start/stop times.
6. Why Certified Medical Billing and Coding Expertise Matters
Hiring or outsourcing to professionals trained in certified medical billing and coding ensures compliance with annual CPT changes, payer policies, and evolving E/M rules. A small upfront investment often saves practices thousands in recovered revenue.
7. How Medical Billing and Coding Certification Programs Improve Accuracy
Billing professionals who complete a medical billing and coding certification stay ahead of regulatory changes. Providers who partner with certified experts benefit from reduced denials, more accurate claim submissions, and fewer compliance risks.
8. Bridging the Gap Between Medical Coding and Medical Billing
Errors often occur when practices treat coding and billing as separate functions. In reality, medical coding and medical billing work best together:
- Coders translate services into CPT/ICD codes.
- Billers ensure codes are submitted correctly and reimbursed promptly.
Integrating both functions under a trusted partner reduces costly errors.
FAQs on Medical Coding Mistakes in 2025
Q1: What’s the #1 medical coding mistake practices make?
E/M under-coding, which often leads to thousands in lost revenue each year.
Q2: Do telehealth coding rules apply the same way to all payers?
No. Some accept the new 98000 series, while Medicare still requires traditional E/M codes with modifiers.
Q3: How often should practices audit for coding mistakes?
At least quarterly to identify trends and fix issues before payers flag them.
Q4: Who’s responsible for vaccine coding errors?
Both providers (for counseling documentation) and billers (for code selection).
Q5: Can outsourcing prevent coding errors?
Yes. Working with a billing partner reduces medical coding mistakes and improves reimbursement.
Conclusion: Protect Your Revenue in 2025
Medical coding mistakes in 2025 are costly but preventable. By fixing the top five errors—E/M misuse, telehealth coding, modifiers, vaccine administration, and prolonged services—your practice can increase revenue and maintain compliance.
At Elevare Management Solutions, we help OB/GYN, pediatrics, and family practices eliminate coding mistakes, maximize reimbursements, and focus on patient care.
👉 Stop losing revenue to preventable errors. Request a Free Consultation today and see what your practice could recover.
References
- American Medical Association – CPT® Codes
- HHS Telehealth – Medicare and Medicaid Telehealth Policies
- CMS – List of Telehealth Services
- Medicare.gov – Telehealth Coverage
- AAPC – AMA Releases Quarterly Update to CPT® 2025
- Society for Maternal-Fetal Medicine – New 2025 Telehealth CPT Codes