Wiki ED Aduiting


Pennsauken, NJ
Best answers
Can anyone provide point on how to audit ED E/M? My physician seem to always complete a Comphrensive History & Exam but MDM get me loss. For example, if a patient comes in with abdominal pain or fever. I don't believe this should be a level 4. Any suggestions????
ED Auditing

There is no quick answer on how to do ED auditing. As a starting point I'd say at least 5 years ED coding experience is needed and CEDC certification, and CMPA wouldn't hurt either. There are audit sheets out there for Emergency Medicine, but experience and certification is the best answer.
As to all of your charts looking like a 99285, that is an issue. Emergency Medicine has had somewhat of a pass since there has been so much low hanging fruit for RACS and OIG. But the OIG is looking at the impact of EMRS on documentation. At some point 10 systems reviewed and 8 systems examined for an ankle sprain is going to be questioned even in Emergency Medicine. The problem with some EMrs is that it is easier to document complete histories and physicials sometimes than to exclude sytems for a lower level service. So in your case the pressure on getting the MDM right is greater. Again there is no short answer (at least I think not) on auditing MDM which is the most subtle and challenging part of determing a level. As I said there are audit sheets out there sometimes that are published by your Medicare carrier that can help.
And you are right Abdominal pain and fever aren't always level 4. Those symptoms could be 99283 or 5 even CC depending on what else is going on, alll of the MDM elm,ents but especially the diagnostics that are done to determine what is going on with the patient (U/S/CT/Blood Work etc), what the provider does (IV meds etc etc). Statistically abdominal pain most often is coded 99284...but it is very dangerous to even think about ED Level coding based on the DX. That only works for DRGS.
But as a starting point you might want to start with talking to your ED Director or compliance person about all of the H&Ps looking Comprehensive. If you don't have an experienced auditor, there are several reputable ED documentation aditing outfits that have been around many years that could help you.