Wiki auditing

[pljames]

what resources do we have for auditing? I need help understanding how the table/grid works and what level of service should have been billed. Senerio would be if you have a new patient comprehensive history and comprehensive exam and a straight forward medical decision making, what level is that for the e/m?

 

[annielou]

My best tool for auditing is from Family Practice Management, called the Pocket Guide to the Documentation Guidlines. It was revised in 1998, and I have used it for several years, but you might be able to contact them and see if it is still available.
The Medicare Learning network has an Evaluation and Management Services Guide for the 1995 guidlines.
You can also check with you local Medicare carrier, who may have an audit form you can download.

 

[FTessaBartels]

New Patient

One difficulty with most audit tools - especially for the newer coder - is that they are designed to help you quantify the three key elements. BUT they typically do not tell you how those add-up to the type and level of E/M service.

pljames asks: Scenario would be if you have a new patient comprehensive history and comprehensive exam and a straight forward medical decision making, what level is that for the e/m?

CPT tells you that for new patients you must meet 3 of 3 key elements: History, Exam, MDM

Anytime you need to meet 3 of 3 you have to code based on the LOWEST of the 3 elements. In your case Straightforward MDM means the highest level you can have is a 2 (99202 or 99242 if outpatient consult or 99252 if inpatient consult).

Hope that was helpful.

F Tessa Bartels, CPC, CEMC