Once a chronic problem has been detected and corrected, you still need to have a maintenance program to keep the practice in optimum legal shape. This can be quarterly or yearly depending on the size of the practice. Second, those who collect from Medicaid, in addition to or instead of Medicare, may have to be more careful than those who deal with Medicare alone. There is therefore no danger of confusion or codes in the Medicare system. There is only one service to be reimbursed for and therefore one corresponding code.
Red flags go up when bills are received with more codes than are customary.
Medicaid, however, offers reimbursement for more than one service, depending upon which state you practice in. Therefore, if you perform one reimbursable service and enter the wrong code accidentally, this can lead to claims of fraud. Likewise, if you perform a service that doesn't fit into a precise category or coding and then attempt to claim under another coded service because it is the closest monetary fit, you could also be opening yourself up to claims of fraud. Knowing the biases of the system, certainly the best idea is to be very careful not to leave any openings for questioning. Make sure you use the correct code for the service provided and document whenever the code fails to cover the treatment provided.