Cardiology Coding Alert

Question: We would like to perform a self-audit of critical care claims in our practice to fix any coding issues we may have and improve our bottom line. We have no idea where to start. Can you help us?

Hawaii Subscriber

Answer: First, you will need to collect a random sampling of critical care claims from your physicians. Review the chart documentation and determine which code you would report for the service, then check what the physician actually billed. Keep a tally of any discrepancies so you know what to discuss with the doctor later, when you can offer the physicians tips on how to select the right code.

Once you perform the self-audit, you can create a schedule of internal audits going forward, expanding that out to other codes beyond critical care. Consider the amount of resources you can devote to the audit while simultaneously conducting day-to-day business.

The more often you can audit, the cleaner your claims will continue. At a minimum, you should conduct an internal audit at least twice a year, experts advise. After you’ve prepared your staff for the auditing process and determined when you’ll perform an audit, you’ll need to define the focus of the audit. Ask: “What do we want to accomplish?” Then focus on the following points:

• The audit’s scope. Which providers, services, date range, and payers will it address?
• How to select charts. Will you fix this process for each provider, or will you randomize the chart selection? Pull charts and organize supporting documentation, such as a printout of physician notes, account billing history, CMS forms, and remittance advice.

Don’t forget that an audit is much more than coding — it involves documentation, coding, billing and data input, denials management, and office process following policies and procedures.