Who Really Cares?
By Jaci Johnson-Kipreos, CPC, COC, CPMA, CPC-I, CEMC
When asked to conduct an audit focusing on Evaluation and Management (E/M) codes, what level of detail should the report provide? The spreadsheet, at a minimum, should have a way to identify the patient, date of service, provider of care, and codes that were billed.
If there is a variance, how much detail in the spreadsheet is needed to provide reasonable feedback to the provider? Is it enough to just reflect code billed and code audited with some written comments? And…who really cares? Does the provider want to know that the documented history did not have four elements of HPI and, therefore, it was not a detailed history and, therefore, it could only be scored as an expanded problem focused and, therefore, could only be a 99202 instead of the 99203 that was billed? Will that level of detail have an educational value?
Is it enough that the comments would reflect that there were fewer than four HPI? Should the report have a column reflecting the level of each of the three key elements? Does the provider read the report to that level of detail? Does the administrator or the CFO? Who really cares?
Or, maybe the provider would only be concerned about any deficiencies in the amount of documented medical decision-making. We stress to the providers how this key component is so important, and we stress how to document the status and plan for all conditions noted in the assessment.
Would the provider want to know that their 99214 only had low level medical decision making? Does the provider want to know that 60 percent of E/M codes billed that required moderate medical decision making only had documentation to support a low level? Who really wants to know that the 60 percent is due to complexity and number of conditions addressed? Or, does the provider only want to know that 99214 did not make the cut and now there will be another audit? Is it the bottom line or the detail? Who really cares? How do we know?
When does it become too much information? Is the type of report and detail determined by the personality of the provider, or can we just say that the bottom line is all the information that is wanted and expected; how we get there is not the focus. Or is it….and …who really cares? Well, other than me, that is.
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