Auditing Other Coders

ARCPC9491

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How do others check the accuracy of other coders in the office? I've been tasked to 'audit' other coders work and not quite sure how to go about it.

Is it as simple as selecting charts at random and checking to see how they coded?

Or is there another method?
 

dmaec

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Morning :)
I've never audited another coders work. We're pretty tight here, usually any questions or issues that come up we discuss to get everyone else's opinion before coding it out.
anyway, I would think they would be random charts - BUT - never simple ;)! you know "us coders" and our opinions! LOL
I guess I would tread lightly, pick random charts, score them out, etc...and see how it compares to what they did. I'm sure there will be slight differences, and I'm sure they'll be reasons why - they might have missed something, or you might...etc.... I would think the audits would be much like when we audit for providers - making sure documentation guidelines are met, charges are captured and things are coded out correctly.

good luck on your audit!

:)
 
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This is a good idea. It helps to generate discussions about those many grey areas in coding if approached in a non-threatening way. It could generate policies and procedures for your office. For example, what is a detailed versus an expanded problem focused exam (95guidelines)? Do you count an HPI element as a ROS element? Where is that instruction published? Does your Medicare carrier have specific guidelines? This could be an exercise in sharing ideas, resources, and coming to common conclusions and could firm up your auditing process--a win-win situation in any setting.
 

Cottrell

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We used to be audited by a lead coder at my last job and they chose 10 random charts and coded them out and compared our codes and theirs. We had to get a 95% or higher error rate. We could of course, go over any differing codes and if we couldn't come to a consensus on who was correct, then our supervisor did. I have the excel spreadsheet we used to use for this. I use it for my provider audits. PM me with your email and i can send you a copy.
 

RebeccaWoodward*

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I like Donna's comment..."We're tight"....

I don't know that I'm in favor of auditors "auditing" auditors within the same practice. At times, this can create conflict between auditors. Often times, auditing is often an art. Auditing is understanding the E/M documentation guidelines, applying them and conveying this information to the staff appropriatley. It is essential that we understand the basics of E/M documentation guidelines but we must also have an understanding and respect for other opinions. For those seriously thinking about obtaining their E/M certification...it boils down to studying, studying, studying. Auditing is not only an art of educating your physicians (within the CMS guidelines) but it is also a treaty within ourselfs to strive to be the best. And for the record...I'd rather have a non-bias opinion.
 
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ARCPC9491

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I totally forgot to mention .... not auditing coder's E/M audits .... auditing surgery cases they coded .... Sorry:eek:

But Rebecca and Donna - I do agree 100% about E/M!
 
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