Wiki new at ER auditing..pls help

[AMANDACPC]

Hello....I just got certified CPC in May and I am currently working as an ER chart auditor. Would anyone have any good hints for me? I am just having an issue with the Risk Level part of it with the ER. I just don't agree that just because someone comes in the ER with ear pain and the Dr gives them a RX for Percoset that it should be a Moderate Risk. I would code that a 99283. I am going to attend the NAMAS class in a couple months but I need something to help me with this till then!! Any help on how to determine the Risk Table?? I'd really appreciate it!

 

[Juliette0416]

Tools

http://www.highmarkmedicareservices.com/partb/reference/pdf/scoresheets/8985.pdf

 

[AMANDACPC]

I am aware of all of the audit forms....i am just unsure about the complexity table.

 

[ahinman]

My suggestion for you would be to talk to your emergency room coders. If you have them available to you that would be your best resource.

 

[LLovett]

Our job is not to determine the clinical appropriateness of the care. If you feel your provider is out of line and giving narcotics inappropriately then that needs to be brought to the attention of the correct person in your organization. They can do the peer review and determine if treatment is appropriate or not and deal with it.

From a leveling point of view, Rx management is moderate risk.

While we can't tell a provider what they did is right or wrong from a clinical point of view, we can ask. I talk to my providers all the time and point things out, ask questions, etc. It find it very helpful to hear their point of view. So if you have concerns let someone know, get it documented. Don't let it cloud your judgement on how the guidelines should be applied though.

Laura, CPC, CEMC