Rosalind Cordini, senior vice president of the Coker Group, and Jeannie Cagle, senior manager, developed this tool to share audit results with physicians.[1] “What we found is helpful is something that’s on one or two pages and is concise and written in physician-friendly language,” Cagle says. The dark gray represents examples of codes where there’s compliance risk (e.g., upcoding). The light gray indicates the practice is losing reimbursement (e.g., undercoding). Everything else was correctly coded. Contact Cordini at rcordini@cokergroup.com and Cagle at jcagle@cokergroup.com.
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PROVIDER NAME/SPECIALTY | ||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|
|
IDPatient |
Patient name and DOB |
DOS |
CPT Billed |
History |
Exam |
MDM |
CPT Supported |
Diagnosis Billed |
Diagnosis Billed |
Diagnosis Billed |
Diagnosis Billed |
Comments |
| 5/30/19 | 99213 | 99213 | 99214 | 99214 | 99214 | M79676 | M79606 | I10 | E663 | Higher E/M code supported, multiple chronic conditions + new problem addressed. | ||
| 5/30/19 |
72100 TC, FY |
72100 TC, FY | M79606 | Spine X-ray ordered and results documented. | ||||||||
| 5/30/19 | 73503-TC, FY | 73503-TC, FY | M79606 | Hip w/pelvis X-ray ordered and results documented. | ||||||||
| 5/30/19 | 73630-TC, FY | 73630-TC, FY | M79676 | Left foot X-ray ordered and results documented. | ||||||||
| 6/10/19 | 99204 | 99203 | 99203 | 99203 | 99203 | F988 | F419 | HPI states compliant with diet and exercise recommended but new patient; treatment for bronchitis inferred to be Azithromycin, other DX listed don’t have documented treatment plan. | ||||
| 6/10/19 | 86580 | 86580 | Z111 | PPD skin test ordered. | ||||||||
| 5/20/19 | 99213 | 99214 | 99215 | 99213 | 99213 | I10 | G2581 | Follow-up visit, documentation supports codes. Be sure to clearly indicate treatment. | ||||
| 5/20/19 | 73130-TC, FY | 73130-TC, FY | S60019A | Hand X-ray ordered and results documented. | ||||||||
| 6/4/19 | 99204 | 99204-5 | 99204-5 | 99204 | 99204 | R12 | F1010 | Multiple issues addressed, treatment plan is inferred. | ||||
| 6/6/19 | 99213-25 | 99213 | 99214 | 99213 | 99213-25 | R05 | Z713 | Documentation supports code. | ||||
| 6/6/19 | 94010 | 94010 | J45909 | Spirometry ordered and results documented. | ||||||||
| 8/28/19 | 99204 | 99204-5 | 99204-5 | 99204 | 99204 | G479 | M5416 | HPI states compliant with diet and exercise recommended but new patient; two incomplete sentences in HPI; multiple referrals made to specialists. | ||||
| 8/20/19 | 99204 | 99203 | 99204-5 | 99203 | 99203 | E785 | M810 | E663 | HPI brief, referred to MD for carpal tunnel but other treatment not documented. 2 RX written. | |||
| 5/28/19 | 99214 | 99213 | None | 99214 | 99213 | R636 | B351 | G8220 | HPI only addressed toenail fungus, no exam documented. Multiple RX written but not connected to treatment plan or DX. | |||
| 5/2/19 | 99214 | 99213 | 99214 | 99213 | 99213 | Z01818 | K469 | Patient seen for pre-op, unclear why RX written, seen 3/21 and written for 90 days. Lower code supported. | ||||
| 5/2/19 | 93000 | 93000 | Z01818 | EKG ordered and results documented. | ||||||||
| 5/16/19 | 99214 | 99213 | 99215 | 99213 | 99213 | I10 | E039 | C61 | Patient presents with no complaints for “med check” - Levothyroxine is adjusted based on labs but no other treatment provided. | |||
| 8/8/19 | 99214 | 99214 | 99215 | 99214 | 99214 | I10 | E119 | I25.10 | E03.9 | Multiple issues addressed, treatment plan is inferred by multiple RX. Also treated I25.10 CAD, E03.9 Hypothyroid and E78.5 Hyperlipidemia but not listed on claim. | ||
| 6/19/19 | 99214 | 99214 | 99215 | 99214 | ? | I10 | N401 | K9041 | Note completed by No Name, MA? | |||
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Accuracy - 42% | ||||||||||||
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Comments: Notes by Dr. P are sometimes brief for HPI, need to include status of chronic conditions or details of presenting problem if acute. Treatment plan is not documented but sometimes can be inferred, other times not. Be sure to include plan for each DX treated and list all DX treated that day to support medical necessity for code. One note was not signed by MD but by MA? Diagnosis codes appropriately selected except as noted above. Educational Session: Discussion with Dr. P included appropriate documentation of HPI and Assessment/Plan, use of most specific diagnoses and relation to treatment plan and EMR issues. | ||||||||||||
