Below is a sample of few findings from the audit. Analyze the findings to help determine issues that need to be corrected and propose recommendations in the compliance plan.
INV# | DOS |
Billed CPT |
Documented DX |
Comments CPT |
DX | ||
501120 | 03/07/16 | 99212 |
272.0 250.00 401.0 |
99213 |
272.0 250.00 401.1 |
Documentation supports a higher level of service than selected by the provider. Per 1997 guidelines – the status of three chronic conditions – extended HPI. The history level and the MDM both supported the higher level of service. | |
504354 | 03/15/016 | 99213 | 529.9 V70.0 V03.89 | 99213 | 529.9 V03.89 | Pass.
V70.0 should not be linked to 99213. It should only be used when a routine examination or counseling is performed. |
|
518295 | 04/15/16 | 99213 71020 | 465.8 | 99213 71020 |
465.8 | Pass | |
518669 | 04/18/16 | 99213-25 96372 J0702 | 477.9 | 99213-25 96372 J0702 |
477.9 | Pass | |
518670 | 04/18/16 | 99214 |
401.1 311 272.4 |
99214 |
|
Pass | |
523310 | 04/28/16 | 401.1 274.9 790.6 | 99213 | 99213 | 401.1 274.9 790.6 | Documentation does not support the level of service selected by the provider. All three of the key components support a lower level of service. The CC and HPI are related to HTN–ROS and Exam only address areas related to the HTN. | |
530994 | 05/18/16 | 99214 71020 |
786.2 110.1 |
99214 71020 |
786.2 110.1 | Pass | |
533372 | 05/25/16 | 99214 71020 | 780.60 788.42 | 99214 71020 |
780.60 788.42 | Pass | |
549344 | 07/06/16 | 99213 | 719.41 | 99213 | 719.41 | Pass | |
550447 | 07/08/16 | 99213 | 239.2 | 99212 | 239.2 | Documentation supports a lower level of service than selected by provider. All three key components support the lower level. | |
554357 | 08/15/16 |
51045 C1875 |
N32.9 | 51045 | N32.9 | Documentation does not support HCPCS Level II code selected by provider. Cannot bill for stent. Review guidelines for global package. |
Another Source: Defining the Core Clinical Documentation Set for Coding Compliance, AHIMA.
Report Audit Results to Educate. (September 1, 2013). Retrieved from AAPC Advancing the Business of Healthcare on January 1, 2017. AAPC.
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