audit

  1. R

    Wiki Eye Exam Documentation

    I conduct medical record reviews (chart reviews) for an External Quality Review Organization. Their Encounter Data Validation task requires providers to submit records and my job is to check and make sure the coding/documentation for the encounter matches the claim that was sent to the MCO...
  2. L

    Wiki Does an auditor ask provider questions?

    Hello! I am hoping to get an answer or any references to be able to answer a question from my provider. Let's say an auditor comes through and is auditing his charts, IF they have any questions will they go ask the provider? I was told no, that they would come in and do their audit, compile a...
  3. R

    Wiki L2114 AUDIT, HELP!!

    I recently appealed a RAC audit for code L2114 that was orginally denied stating "documentation did not support that the billed custom-fitted item required more than minimal self adjustment at the time of delivery in order to provide an individualized fit, and included a detailed description of...
  4. E

    Wiki E/M Time Coding without Supporting Documentation

    I have a provider that submits level 4 and 5 E/M codes on nearly every claim stating that he spent the relevant amount of time with the patient to support that level code. He adds the saying that more then 50% of his time was spent counseling or coordinating care for the patient. The rest of his...
  5. M

    Wiki Help with documentation

    We have a new medical provider who does not state the diagnosis or symptoms in his notes. The diagnosis codes are selected by the provider from a drop down list on another page, but not stated in the documentation portion of the note. My job is to determine the level of E/M and I'm worried about...
  6. tetrok

    Wiki “Edema, bilateral lower extremities”

    Having a disagreement with billing the symptom of “edema, bilateral lower extremities” Colleague insists R60.0 Localized Edema I had been trained most specific code for this is R22.43 Localized swelling, mass and lump, lower limb, bilateral Tried explaining the medical definition of edema IS...
  7. C

    Wiki NP DNP

    Hello my fellow AAPC members. I am looking for advice. I have a provider who is a NP DNP and started her own practice in NY. She has worked as an NP under another practice for years treating patients under an MD. She hasn't been with him for over a year now. Her specialty is pain management...
  8. M

    Wiki ICD-10 codes in progress note vs codes on claim

    The software that we use allows the provider to add diagnosis codes to a section of the progress note, however a lot of the time the codes are not correct (eg. documentation says "Diabetes Type I", but provider lists code for DM type II). My supervisor insists that I need to contact the provider...
  9. alvesey

    Wiki Audit Risk When 1 Dx Code is Listed on Claim When Multiple Exist in Notes?

    My employer is having software issues and a (hopefully temporary) fix has been proposed to include only 1 Dx code per claim. Are we increasing the risk of getting audited? We are a community mental health facility and serve a high Medicare/Medicaid population. Thank you for any assistance...
  10. R

    Wiki Report Cards for Providers

    Hello! I am a coding quality auditor for a very large dermatology billing and coding LLC. I can provide providers feedback when I audit them by reviewing audited claims and error rates however, I am looking to do something a little different. I want to set up a provider "report card" that would...
  11. V

    Wiki GI Op Reports Audit Tool

    Hi, Does anyone have an Endoscopy and/or Colonoscopy Audit tool they are willing to share:
  12. C

    Wiki Auditing Dental services

    Does anyone have experience auditing dental services on the payer side that may possibly be able to chat or PM with me? Thanks
  13. A

    Wiki 90696 for patients outside of 4-6 years old

    Hello, The nurse at our clinic who administers vaccines sometimes admins a 90696 for kids outside of the 4-6 age rage. She says it's due to patients being behind on their vaccines and circumstances like that. Can I code this a a DTaP 90700 and IPV 90713 separately? Or do I have to use the...
    • Agilbert3
    • Thread
    • audit compliance cpt family practice vaccines
    • Replies: 2
    • Forum: Pediatrics
  14. B

    Wiki SNF Therapy Audit help! Level 3 dispute!

    This is going to be long, and I apologize. I need some help from anyone with SNF experience, especially with billing of CPT codes. Here goes.... The first denial came back stating: "The 5 day assessment, ARD 8/3/17 pays for 8/1-8/3/17 and the 14 day/COT assessment ARD 8/10/2017 pays for...
  15. N

    Wiki E&M coding w/o diagnosis

    My physician documented in the assessment part of his note and billed a diagnosis of shoulder pain, however he also diagnosed osteoarthritis in his x-ray results. Since there is a definitive diagnosis, I know this should be replacing shoulder pain. If the note gets audited, will the pain dx be...
    • nina_930
    • Thread
    • assessment audit diagnosis e&m pain
    • Replies: 1
    • Forum: E/M
  16. C

    Wiki coding chronic condition icd10 from problem list

    Scenario: Patient comes in for a visit with his FP doc to discuss his chronic cough. The MD just notes the discussion of the cough but the patient has diabetes, HTN, etc in his problem list and he refills his HTN meds and DM meds that day both of which are documented in his note for that day...
  17. C

    Wiki checklist for audits

    Hello, Does anyone have a sample checklist for when payers are requesting charts for an audit? For example I'm looking for the following documents: chart note, procedure note, consult letter, etc? I want to be sure we have all needed documents per chart. Thanks, Camille Waterhouse, CPC
  18. C

    Wiki Consult documentation requirements

    I am looking for clarification. A consultation requires the written or verbal request for consult may be made by a physician or other appropriate source and documented in the patient's medical record by either the consulting or requesting physician or appropriate source. The consultant's...
  19. C

    Wiki 30140 vs 30802 medical review denials

    Is anyone having CPT 30140 denied during medical review by Onet for Aetna? We are billing Aetna for CPT 30140 and when Aetna sends the operative notes to Onet for review, Onet denies the 30140 and states that CPT 30802 is supported instead. CPT 30140 Submucosal resection inferior turbinate...
  20. P

    Wiki Review of Systems audit perfection

    I am the Medical Director of a surgical group practice. We recently started using a new auditor for our medical records. The new auditors keep excluding our Review of Systems as invalid because they might not exactly match the rest of the medical record. I have argued that the review of...
  21. A

    Wiki CPC-A Looking For Employment ANYWHERE

    Good Day! My name is Jeanette Archibeque and I live in Roswell, NM. I recently separated from my most current employer and I am looking for a new opportunity. I currently have a CPC-A with an A.A.S in Medical Billing and Coding. I have about three years of experience in the medical field. I...
  22. M

    Wiki Join Petition to Edit HIPAA Language

    Your help is needed. Please review the following petition link and sign. HIPAA Privacy Rule "Right of Access" the designated record set 45CFR164.501...
  23. K

    Wiki Hipaa violations and state auditors

    Is it a hipaa violation to allow an auditor to use a providers office to work in while they do an audit? I realize that the auditor has the right to request any records they need to complete the audit. However, I am unsure if that is the same as allowing them to be in a messy office with...
  24. M

    Wiki Oncology Dx

    Reaching out to oncology practices, we recently had a professional audit team come in to audit our records they stated diagnoses must be coded off of progress notes only, however in the past we have used pathology reports to confirm diagnoses. Can anyone else give us direction as to how you...
  25. K

    Wiki contrast injected x 2/no cath movement help?

    Can anyone please help with a lower extremity angiogram. Dr places cath in the aorta 36200 via common femoral artery. Then a suprarenal aortogram was taken with 10 or 20 contrast. Then the dr states lower extremity runoff was taken with 7 for 70 contrast. He didn't document the catheter movement...
  26. J

    Wiki Managing Coders/Auditors

    I am being asked to manage a team of coders/auditors and track their accuity and accuracy. Does anyone have a format or excel sheet that they wouldn't mind sharing for ideas? I am open to suggestions. Thanks! jfischer@gvh.org
  27. D

    Wiki Use of 99080

    Several software programs only allow you to submit 4 ICD9 codes with each claim. As we all know, capturing all diagnostic codes is a must with HCC's. So in order to capture the additional ICD9 codes, we are using 99080 to submit the additional codes. Do you see a problem with using that code...
  28. D

    Wiki Additional Submission Code

    The first question is about diagnosis codes submitted which are normally beyond our software capabilities. The second question is how we notify health plans about additional diagnosis codes not previously submitted from an internal chart review. For example of the first question, many of our...
  29. M

    Wiki 1997 Audit Tool

    Does anybody know where or have a 1997 audit tool or sheet or form??? I did an internet search and it looks like all of them are 1995 based! :eek:
  30. J

    Wiki Oncology coding audit-Macomb, MI

    I am looking for a certified coder that can audit a hospital owned oncology/hematology practice located in Macomb, Michigan. The audit is expected to last approximately six weeks. You will have access to the charts, Monday-Friday from 8am-4:30pm. If interested, please e-mail me at...
  31. R

    Wiki Audit Tool

    Hello, I hope someone can help me, I am looking for a 'new' audit tool that goes by points. Not new to the auditing world but new to me. We use a different method and I am not sure it captures the risk involved and wanted to compare to the point system to see if it is off and if so how far...
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