Orthopedic Coding Alert

Consider 9 essential criteria when you sit down with your audit materials

Orthopedic coders who have never performed a self-audit may wonder whether they have what it takes to complete the audit. But if you tick a few simple options off of our checklist, you-ll be on the right track.

If you don-t  know quite where to begin when you perform your first self-audit, keep this handy reference with you as a guide to remind you what types of questions you should be asking yourself. For each chart, make sure you can answer the following questions, and you-ll know you-ve done a thorough job:

Audit Checklist

- Does the documentation in the chart support the level of E/M service that the surgeon billed?

- Does the documentation in the chart support the CPT and/or HCPCS codes for non-E/M services, such as surgeries, that the surgeon billed?

- If the physician coded a consult, does documentation of a request from a third party exist in the chart? Does the chart contain a written consult report back to the third party?

- Did the physician use modifiers correctly?

- Does the physician's documentation support the ICD-9 codes the practice reported?

- Did the physicians date all entries?

- Is the chart legible?

- Are the names and identification numbers of the patient and provider on each page of the claim form?

- Does the patient identification sheet include completed biographical data, including the patient's address, employer, home and work telephone numbers, and marital status?