Urology Coding Alert

Know your goals and expectations. 

If you aren’t quite sure where to begin when getting ready to implement internal audits in your urology practice, use this handy reference as a guide to remind you what types of questions you should be asking. Use checklist one to set your goals and then turn to checklist two to ensure you are identifying any potential problems with your practice’s coding and billing.

Checklist #1: Determine Audit Details

Your first step in the auditing process is to narrow the parameters of your audit. You should answer the following questions before you get started:

What is the focus of the audit?

You need to know exactly what you want to accomplish.

What will the audit’s scope be?

Consider which providers, services, date ranges, and payers your audit will address. Look at areas such as incident-to billing, modifier use, and code edit unbundling.

How will you select charts?

Will you fix this process for each provider, or will you randomize the chart selection? You should select a minimum of 20 charts per provider for your review. That chart selection should include a variety of types of services, including E/M services, consultations, hospital services, and surgical procedures.

What documentation will you review?

Pull charts and organize supporting documentation, such as a printout of physician notes, account billing history, CMS-1500 forms, and explanations of benefits (EOBs) to review during your audit. If your practice is doing everything according to what the payers require, the next step is to determine whether you have supporting documentation.

Why am I finding denials?

During an audit, or even during a separate billing review, you should be reviewing denials. If your review shows that your billing practices are perfect, but claims are still being denied, you need to investigate.

Checklist #2: Identify Areas for Improvement

For each chart you audit, make sure you can answer the following questions and you’ll know you’ve done a thorough job:


Does the documentation support the level of service billed?

Does the documentation support the CPT^® and/or HCPCS codes 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 documentation support the ICD-9 codes the practice reported?

Did the physicians sign and date all entries?

Is the chart legible?

Is the name and identification number of the patient and provider on each page of the medical record and 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?