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E&M Auditing

  1. #1
    Default E&M Auditing
    Medical Coding Books
    I do coding for a Hospitalist group and we are doing more and more audits to try and get the Doctors to assign more appropriate E&M codes according to their documentations. We just recently got an auditing software, intelicode, to make our audits more professional, but after using it my co-worker and myself are more confused with the auditing process now. All along, when we have been using the 97 guidelines for the Exam part, we have always counted every element and as long as we had 18 elements we considered it a high level for that component.However, with using this Intelicode, it seems that it won't give us a high level on the exam UNLESS there are atleast two elements per organ system on 9 organ systems. Can any one help us on a reference or what the appropriate guidelines are for auditing an exam?

    Thank You!

  2. #2
    It is in the 97 guidelines, page 14.

    • Comprehensive Examination--should include at least nine organ systems or
    body areas. For each system/area selected, all elements of the examination
    identified by a bullet (•) should be performed, unless specific directions limit
    the content of the examination. For each area/system, documentation of at
    least two elements identified by a bullet is expected.

    Laura, CPC

  3. #3
    The link below should get you to Medicare's website and to the E/M guidelines. Click on 1997 guidelines for more detail. (If the link doesn't work just copy & paste it in the address field).

    Hope this is useful.

  4. #4
    Thanks to you both, that helped us out with finding an answer.

  5. Default E&M Auditing Software
    Can you recommend the most user friendly reliable E&M auditing software? I have been assigned to do a friendly audit for my boss, who runs a large IM practice in NoVa. I want to do 300 charts. I went to the NAMAS class for CPMA, and I found the manual system of auditing in class to be aggravating, and open for error. I understand how important and necessary it is to understand the process of auditing, but when it comes down to actually auding large numbers, software is a usefull tool. Thank you!!

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