Wiki Audit Scoring E/M, CPT, ICD-10, Modifiers

[nolanspade]

Hello,

We are developing our audit process, and are wondering how other practices are scoring their internal audits with regard to diagnosis codes. Are you scoring the diagnosis codes individually, and counting each as a point, are you counting one point for the group, or do you not count at all? Any answers are appreciated!

Thanks,

Nolan

 

[dje10008]

We count diagnosis codes individually. For example, if there is 10 dx listed on one encounter and our coders missed one our of 10, their score would be 90%.

 

[LGillstrom]

We count diagnosis codes individually. Each diagnosis code is worth one point. However, we do separate the first-listed diagnosis code from the remainder of the diagnosis codes, particularly when performing surgical audits as the first-listed diagnosis codes are often the reason a claim is (or is not) covered by the insurance. This does NOT mean that we score based on what is covered, we score ONLY what is documented, however, if the first listed diagnosis is incorrect, a claim can deny.

 

[ggoode66]

We also count each diagnosis that is listed and also look if any that should have been there but were missing. We also look at the sequencing, and have a few things that are listed as observations so we are checking but doesn't go into the final score. Things that don't really effect payment like Z/status codes