auditing

  1. C

    Question HPI question

    Did the HPI rules change in 2023? I cannot find any documentation regarding it. I am reading my CPMA textbook and it says I can find the guidelines in the CPT book annnnnd I am not finding anything current. The textbook still says we use 95/97 guidelines for auditing HPI. Any help is appreciated!
  2. P

    Wiki Clinical Indication of Lung Metastasis

    I am working on a practice test for auditing thru the AAPC. One of the questions includes this in the documentation: "Clinical Indication: Non-small-cell lung cancer with suspected metastasis" also from the medical record: "CONCLUSION: 1. No finding suggestive of metastatic disease." One of...
  3. G

    Wiki Chiropractic Physician, CPC-A, MCS-P (Compliance Specialist)

    I am seeking full time employment in coding, auditing, and compliance work. I have practiced Chiropractic (Family practice, portal of entry) for 23 years, I have been a Compliance Specialist and Officer for my practice for 3 years, and a newly minted CPC-A. lastly, I am a post-graduate...
  4. T

    Wiki Intra-operative monitoring technical component

    Hello, I work for a small IPA and we are trying to figure out what is correct for the technical component of IOM. I have been denying them because I assumed the technical component was payable to the facility, but I am not sure that is correct, because there is a tech and the neurologist. Does...
  5. M

    Wiki Can a modifier be added at the request of the insurer even if CMS/AMA guidelines don't require one?

    We have some CPTs that have been denied by an insurance company for "missing modifier". CPT 99291 was paid then the payment was recouped as "within global period". After our appeal, we received a letter that stated "the claim submitted did not have a modifier appended to the E/M service"...
    • mcochran
    • Thread
    • auditing incidental legal modifier mutually exclusive ncci
    • Replies: 2
    • Forum: Modifiers
  6. emeskina

    Wiki Coding all documented conditions...

    ICD-10-CM coding guidelines instruct coders to accurately capture secondary dx as documented/addressed by the provider in the body of their note and A/P to the highest specificity. We are also instructed to code all documented conditions that co-exist at the time of the encounter/visit AND...
  7. C

    Wiki Coding and billing from incomplate records

    I am questioning the legality and ethical propriety of coding and billing medical procedures from the doctor's handwritten notes on the patient's hospital facesheet. In this situation, the doctor is recording the date, the procedure and Dx description for hospital inpatients on the patient's...
  8. C

    Wiki Coding and billing from incomplete records

    I am questioning the legality and ethical propriety of coding and billing medical procedures from the doctor's handwritten notes on the patient's hospital facesheet. In this situation, the doctor is recording the date, the procedure and Dx description for hospital inpatients on the patient's...
  9. C

    Wiki Coding & billing from incomplete records

    I am questioning the legality and ethical propriety of coding and billing medical procedures from the doctor's handwritten notes on the patient's hospital facesheet. In this situation, the doctor is recording the date, the procedure and Dx description for hospital inpatients on the patient's...
  10. V

    Wiki GI Op Reports Audit Tool

    Hi, Does anyone have an Endoscopy and/or Colonoscopy Audit tool they are willing to share:
  11. Z

    Wiki ROS Confusion

    Can a Review of Systems be counted as complete if it appears as the following on a note: Review of Systems Below systems reviewed with the patient's wife, all are negative except as noted above General ROS Allergy and Immunology ROS Hematological and Lymphatic ROS Endocrine ROS Respiratory ROS...
  12. B

    Wiki Audting Practice

    Hi! I am studying for my CPMA and I plan on sitting for the exam in October. Does anyone know of any other resources that offer auditing practice using the CMS guidelines? I would really like to practice more charts before i sit for the exam since this is a large part of the exam. Thank you...
  13. J

    Wiki changing level of E/M

    I do internal auditing of E/M levels. I was initially asked to do this in order to educate the provider on how to improve documentation in order to better support the billed level of service in the future. The company is now asking me, pre-billing, to place an addendum on the provider's note...
  14. R

    Wiki Coding Wheezing and Shortness of Breath

    Hello everyone, This is my first time posting a questions here.... I am auditing a medical denial for our laboratory claim and Medicare is asking for a supportive diagnosis code. Wheezing was already coded but unfortunately that doesn't cover the tests being denied. So within the report...
  15. C

    Wiki Help: ROS negative findings-- what is appropriate?

    I have always been taught that in auditing a chart note that the word "negative" will not count, and for at least one body system needs to specify the negative findings and then the provider can say all other systems negative. Is this correct? Does anyone know What Medicare rules are? I am...
    • Chapman86
    • Thread
    • auditing negative ros
    • Replies: 1
    • Forum: E/M
  16. B

    Wiki Newly Hired Auditor - What To Study/Learn?

    Hello! I was recently promoted to an auditor with my organization. Other than the OIG Work Plan, what other documents and/or books should I read to get up to speed on what is important in auditing for 2018? I would greatly appreciate any suggestions and advice. Thank you.
  17. christinav

    Wiki Critical Care Audit Question

    I am currently auditing Critical Care Services and there is a physician who provides the EHR signed document that does not indicate that it is a Critical Care document, but will then Write using a normal pen on the bottom of the last page stating the total time spent providing critical care...
  18. T

    Wiki E&M Hematology Oncology

    I am a new Auditor for E&M charges with Hematology Oncology practice. I am looking for any education sites or cheat sheets that anyone finds helpful. My email is tracy_mcpherson@aol.com. Thank you
  19. D

    Wiki Looking for opinions on capsule reading and billing global

    Good Afternoon All, If a provider is buying the capsule cams, has the download center equipment and is paying someone to read their capsule but then reading it themselves and signing the note that the provider read the test; would this be allowed in order to bill globally? I was told if the...
  20. C

    Wiki code corrections and modifiers

    Ultimately the physician is responsible for codes, modifiers and diagnosis that are submitted on a claim. I am looking for information on what a certified coder can do vs. a non certified medical biller. Can a medical biller who is not certified add a modifier to a claim or must this be done...
  21. B

    Wiki Help Needed: Project and Research Question-Correct an Edit

    Hi everyone, I am stumpt on this preoject/research question below, any assistance would be so greatly helpful :) Thanks so much, Brittany- CPT code 77003 is present under revenue code 320. CPT code 64490 is present under revenue code 360. An NCCI edit is present on code 77003 and reads...
  22. P

    Wiki E/m hpi

    Really quick question..... we are having interoffice 'discussions' on this and I am looking for outside opinions. A patient comes in for pruritus. HPI states info regarding that symptom. Detailed exam is done as patient also has hypertensive kidney disease and DM. Those two issues are...
    • phycoder
    • Thread
    • auditing evaluation and management
    • Replies: 2
    • Forum: E/M
  23. D

    Wiki Multiple Patient Charts same patient

    Is anyone aware of any authoritative source that addresses the impropriety of keeping multiple patient charts on the same patient who is covered under different payor types?
  24. A

    Wiki Recent Certified Risk Adjustment Coder; seeking Remote coding, or validation position

    CRC with 1+ year experience at Risk Adjustment Data Validation Audit Firm. One more fulltime semester. Graduating in May with a business degree. Seeking remote practical experience as intern, or entry level position with coding, or auditing firm.
  25. F

    Wiki Review of Systems

    Please help! One of the physicians in our practice routinely uses this statement when making an initial hospital visit or consult: "Review of systems: Reviewed. The patient's review of systems found on the patient's chart under physician documentation is noncontributory." How could that even...
    • fltbaroque
    • Thread
    • auditing e/m review of systems
    • Replies: 2
    • Forum: E/M
  26. D

    Wiki Question for you Gastro billers out there!

    Hello All, I wanted to get some opinions on a few things: 1. If my doctor sees a patient prior to colonoscopy screening and the patient is there to just go over the colonoscopy steps and sign consents. Are we able to charge for this visit? I have seen where it states if just there for a...
  27. S

    Wiki Medical necessity in the hospice realm

    As a nurse auditor, I'm often presented with cases & claims for dates of service where it's pretty obvious that a recipient doesn't qualify for hospice services based on medical necessity. What we're having difficulty with is rephrasing that terminology so it can be adequately defended if we go...
  28. A

    Wiki CPCO Certification - course through AAPC

    Hi all, To whom already certified as CPCO, or planning to take the CPCO, how do you plan or already passed the certification? What kind of courses are you taking? Did you pay for the $1500 ($1200 on sale until 3/31/2016) for the course through AAPC? If so, how much did that help you with the...
  29. M

    Wiki Best Auditing Tool to use?

    Hello Fellow Coders, i hope you all are healthy and doing well. I have recently started an auditing position (which i have done in the past) but I have several different tools I can use to determine the correct E/M level. Is there an easy to look at tool that you auditors prefer to use when...
  30. J

    Wiki EMR access requiring full SS# for contract coding

    I work for a national coding company doing contract auditing. I have a contract with this company. This company signs contracts with facilities in which we provide the services and more and more we are being required to get access into their EMR's to locate the documentation that needs...
  31. J

    Wiki Remote PRO FEE/ED Auditor Needed FT

    Exciting Remote opening to join the HCCS Auditing team. If this is something that interests you, please email me your resume to my contact information listed below. We currently have an opening for an experienced, certified, and remote Pro Fee and ED Auditor. In this role, you will be...
  32. K

    Wiki Dermatology auditing tool

    I am in need of a Derm auditing tool. Is it possible to have someone send me a form or direct me to a website to check my E&M codes for Derm specialty. Thank you! Kathy k.kasper@cascadeeyeskin.com
  33. C

    Wiki Auditing form / Ophthalmology E&M assistance

    Any ideas where I can find an auditing form that can be easy to utilize for the eye exam? Thanks,
    • CODING1234
    • Thread
    • auditing easy exam form utilize
    • Replies: 2
    • Forum: E/M
  34. C

    Wiki Auditing sheet for Ophthalmology

    I need assistance finding a good auditing form for Ophthalmology. I need assistance counting the bullets... any help is appreciate .
  35. S

    Wiki What is your go to refrence that is not the DG's or google?

    I know there are lot of books that provide guidance for documentation and auditing of E/M services. I'm curious which one book is your go to . . . ?
  36. P

    Wiki Compliance / Physician Coding Auditing Books

    Hello fellow coders, I am in the process of ordering auditing materials for Physician E/M and pro-fee surgeries and would like to know if there are auditing books/tools that you would recommend. Thank so much for your input.
  37. B

    looking for work from home

    Barbara Deaton, CPC 860 Carpenter Drive Hollister CA 95023 (831) 630-1302 skidder56@gmail.com POSITION DESIRED: SENIOR SPECIALTY CODER Professional Attributes: Certified Professional Coder, 24 years coding experience/15 years abstract coding, current member AAPC, proven strong work...
  38. S

    Wiki E/M MDM Table 1: Self limiting/minor vs. New Problem

    I have been an auditor for several yrs and have never considered a self limiting or minor problem as a New Problem on the Med Dec Making Table of Risk (Table 1) # of Dx or Management Options. In my opinion and due to the fact that there is a separate box for self limiting (1 pt), it would need...
    • scottshar
    • Thread
    • auditing compliance e/m
    • Replies: 1
    • Forum: E/M
  39. L

    Wiki 2 out of 3 in E/M

    I have a provider who documents only two of the three key components for extablished patients, because only two of the three are required to assign the E/M. The result is no CC (just follow-up), HPI, ROS or PFSH. Is this code-able at all? Thanks, Lin CPC
    • losborn
    • Thread
    • auditing e/m key elements
    • Replies: 4
    • Forum: E/M
  40. S

    Wiki Ophthalmology Practice - E/M Documentation Issue

    Who can document the Exam elements in an Ophthalmology practice? Is it strictly the MD/OD or can the C.O.T. (tech) document and have them be counted as exam elements to establish the E/M level that is being billed? I am in the process of starting a chart audit in the practice I work at and am...
  41. B

    Wiki MDM & Sx

    :confused: If a patient is referred for a pre op visit by a specialist. Is it appropriate to use the "Elective major sx" on the Table of Risk? I can not find any documentation supporting or disputing this. Thanks
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