Wiki E/M Audit

I am about to begin an E/M audit in our facility. Does anyone have any pointers or useful audit templates they used?

I like Trailblazer's: http://www.e-medtools.com/Aqua_Medicare_Coding_Worksheet.html
I made my own "score sheet" for providers in Excel that allows me to show what I gave credit for including in the exam (We use 1997 guidelines only, at the moment.) - My spreadsheet's not perfect, but it works... I can email it to you tomorrow, if you want.;)
 
I like Trailblazer's: http://www.e-medtools.com/Aqua_Medicare_Coding_Worksheet.html
I made my own "score sheet" for providers in Excel that allows me to show what I gave credit for including in the exam (We use 1997 guidelines only, at the moment.) - My spreadsheet's not perfect, but it works... I can email it to you tomorrow, if you want.;)

Hey Brandi:

Would you mind sending me a copy of the score sheet you created. I'd like to take a peek if you don't mind...

rthames@heritagmedgrp.com

Thanks much!
 
We use Intellicode for our Audits. It's a nice program, easy to use and has a lot of reporting features. It also has a print out available after each audit that can be used to show the provider.
 
Hi Brandi,
I would also love to have a copy!
Thanks,
kmereo@aol.com

I got it sent to you guys...I'm sure everyone's figured it out by now, but I just noticed that the Excel file opens up to the form that I had completed the example on (Sheet2) - the blank form is on Sheet1. kmereo - I fixed it on yours, so it should be fine. Hope everybody likes it! :D
 
Cemc

Does anyone know what E&M exam template is used for the CEMC exam. Is it 1995 or 1997 general multisystem exam or must we use both to determine the level. I was told the exam uses only the 1995 template. Does anyone know for sure.
 
I took the exam in 2009 and I took both 95 and 97 with me. I recall a few questions where it told me to use one or the other and even both. Take them both.
 
Official Exam guidelines

Does anyone know what E&M exam template is used for the CEMC exam. Is it 1995 or 1997 general multisystem exam or must we use both to determine the level. I was told the exam uses only the 1995 template. Does anyone know for sure.

I believe the official exam guidelines instruct you to bring BOTH 1995 and 1997 audit tools/ templates with you. When I took the exam there were a couple of scenarios where you were asked to code based on a specific set of guidelines. In at least one case you had multiple questions on the same note - Q1: code based on 1995 / Q1: code based on 1997.

Good luck

F Tessa Bartels, CPC, CEMC
 
I believe the official exam guidelines instruct you to bring BOTH 1995 and 1997 audit tools/ templates with you. When I took the exam there were a couple of scenarios where you were asked to code based on a specific set of guidelines. In at least one case you had multiple questions on the same note - Q1: code based on 1995 / Q1: code based on 1997.

Good luck

F Tessa Bartels, CPC, CEMC

You can bring a copy of the guidelines themselves (which I would strongly recommend), and any audit tool you're comfortable with. My little tool only has 1997 guidelines, because that's all I need, but most tools out there don't make the distinction, or they have areas from both guidelines for you to use on the same form. I took the Trailblazer tool to sit for my exam, and it worked out well for me, so it's just your preference, really. Hope that helps! ;)
 
Related question on the CEMC exam

It states that you can bring an audit tool with you. My question is if that means one copy/sheet of the tool you usually use, or can you bring more copies - one for each case you will be coding for the exam?

I am taking my CEMC on the 29th. Feeling confident and ready for it - a change for my usual test anxiety. Hope this doesn't mean I am overconfident and blow it!

Thanks.
 
Auditing ROS and acceptable phrases

Can anyone tell me if the following is acceptable?

REVIEW OF SYSTEMS: 10 of 14 systems reviewed and are negative except noted above.

"Above" is talking about Cheif Complaint. Going back to my class days I remember that if the doctor didn't document specifically we can't assume what systems he is talking about.

What's your thoughts?
 
No that is not acceptable! CGS put it like this: "when using the "negative" notation, always identify which systems were queried and found to be negative" in a recently published article called Tips for Preventing Most Common Evaluation and Management Service Coding Errors. Sorry I do not have the link, I just have the printed article.

I am also getting the same instruction from private insurance carriers.

Hope that helps :)
 
Can anyone tell me if the following is acceptable?

REVIEW OF SYSTEMS: 10 of 14 systems reviewed and are negative except noted above.

"Above" is talking about Cheif Complaint. Going back to my class days I remember that if the doctor didn't document specifically we can't assume what systems he is talking about.

What's your thoughts?

Umm, that's a negative from me as well. What systems were reviewed? How would you know that none of those negatives were 'pertinent' negatives, without knowing which systems are being referred to? If he doesn't feel like taking down the ROS by himself, he should consider having the ancillary staff do it for him. Then all he needs to do is show that he reviewed/confirmed the information, by adding a notation at the bottom like "Symptoms reviewed as listed above" or something like that... Hope that helps! ;)
 
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