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Auditing for a family practice

  1. Default Auditing for a family practice
    Medical Coding Books
    Can anyone tell me which guidlines they use when auditing for a family practice?
    Thanks in advance for your help

  2. Default
    I'm a new to auditing and one of the clinics I am working on right now is a family practice. I'm using the Marshfield Audit Sheet and use the 97 guidelines.

  3. #3
    Default 95's
    I find the 95's are most often advantageous to the physician, but it really depends on their documentation style. Most MDs I've audited do not adhere to the "bulleted guidelines" in a way that allows for level 4 and 5 services when the 95's do.

    The audit tool Amy lists is an ED-specific tool and is not appropriate for family practice. I have a form that works great for all settings if you want to send me your email address. It is too large to upload here.

  4. Default
    Thanks for the tip, I'm new to auditing. Can I have a copy of your tool as well? Please & Thanks! My email is

  5. #5
    Quote Originally Posted by JCampbell View Post
    Can anyone tell me which guidlines they use when auditing for a family practice?
    Thanks in advance for your help
    In my current employer they were all trained and use the 97 guidelines. My former employer used both. I had one physician who would when seeing a patient in the office use the 95 and when seeing patients in the hospital use the 97 guidelines.

    I was more familiar with the 95 as I audited FP and IM but have since starting being more comfortable with the 97.
    Roxanne Thames CPC, CPC-I, CEMC

    "Remember the greatest gift is not found in the store but in the heart of true friends"

  6. Default
    That would be great if you could send it to

    Thanks for everyones help!

  7. Default
    I agree that the 95 guidelines are more beneficial to a family physician addressing multiple systems - i believe that you can switch back & forth (different patient encounters, of course) and audit different encounters with different tools and guidelines.

    Just don't switch back and forth in the same encounter.

    For example, an injury related visit - I would use the 1997 guidelines..(musculoskeletal). you just need to be able to communicate to the auditor which guidelines were used.

    Really, the only difference between the two is in the exam portion of the audit.

    I have an audit tool that was written by someone at AAPC from a seminar I attended recently (E/M Auditor Boot Camp) if you're interested.

  8. #8
    Kansas City, MO
    I agree that 95 is usually more favorable when it comes to family practice.

    If you can get your docs to use 97, I think that'd be great. If they are documenting to hit exact bullets, as required by 97, then their documentation will probably fare better in an audit.
    Linda Vargas, CPC, CPCO, CPMA, CPC-I, CEMC,CCC, AAPC Fellow
    PMCC Licensed Instructor
    2018 Chapter President, Kansas City, MO

  9. #9
    I would like to get into auditting and coding from documentation, how can I educate myself,so that i am comfortable. Does anyone have any suggestions. I currently work for Family practice but we still use encounter forms and doctors mark the e/m.

  10. #10
    Default Study guides
    I know the AAPC has study guides you can purchase, but the best thing that you can do for free is download the 95 and 97 guidelines from CMS and memorize them. They are the basis for E/M auditing and you must know all the rules and ins and outs to be an effective auditor. E/M University is a great web site that has some coding exercises and a case of the week for practice with rationale for code selection and then there's getting an audit tool and actually practicing. It's best if you can take a class or have someone mentor you if you know anyone in your local chapter, perhaps, that is willing. Medical terminology is a must as is determination and research. Good luck!

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