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Sample Tool for Physician Feedback After an Audit

Rosalind Cordini, senior vice president of the Coker Group, and Jeannie Cagle, senior manager, developed this tool to share audit results with physicians.[1] “What we found is helpful is something that’s on one or two pages and is concise and written in physician-friendly language,” Cagle says. The dark gray represents examples of codes where there’s compliance risk (e.g., upcoding). The light gray indicates the practice is losing reimbursement (e.g., undercoding). Everything else was correctly coded. Contact Cordini at rcordini@cokergroup.com and Cagle at jcagle@cokergroup.com.

PROVIDER NAME/SPECIALTY

IDPatient

Patient name and DOB

DOS

CPT Billed

History

Exam

MDM

CPT Supported

Diagnosis Billed

Diagnosis Billed

Diagnosis Billed

Diagnosis Billed

Comments

5/30/199921399213992149921499214M79676M79606I10E663Higher E/M code supported, multiple chronic conditions + new problem addressed.
5/30/19

72100

TC, FY

72100

TC, FY

M79606Spine X-ray ordered and results documented.
5/30/1973503-TC, FY73503-TC, FYM79606Hip w/pelvis X-ray ordered and results documented.
5/30/1973630-TC, FY73630-TC, FYM79676Left foot X-ray ordered and results documented.
6/10/199920499203992039920399203F988F419HPI states compliant with diet and exercise recommended but new patient; treatment for bronchitis inferred to be Azithromycin, other DX listed don’t have documented treatment plan.
6/10/198658086580Z111PPD skin test ordered.
5/20/199921399214992159921399213I10G2581Follow-up visit, documentation supports codes. Be sure to clearly indicate treatment.
5/20/1973130-TC, FY73130-TC, FYS60019AHand X-ray ordered and results documented.
6/4/199920499204-599204-59920499204R12F1010Multiple issues addressed, treatment plan is inferred.
6/6/1999213-2599213992149921399213-25R05Z713Documentation supports code.
6/6/199401094010J45909Spirometry ordered and results documented.
8/28/199920499204-599204-59920499204G479M5416HPI states compliant with diet and exercise recommended but new patient; two incomplete sentences in HPI; multiple referrals made to specialists.
8/20/19992049920399204-59920399203E785M810E663 HPI brief, referred to MD for carpal tunnel but other treatment not documented. 2 RX written.
5/28/199921499213None9921499213R636B351G8220 HPI only addressed toenail fungus, no exam documented. Multiple RX written but not connected to treatment plan or DX.
5/2/199921499213992149921399213Z01818K469Patient seen for pre-op, unclear why RX written, seen 3/21 and written for 90 days. Lower code supported.
5/2/199300093000Z01818EKG ordered and results documented.
5/16/199921499213992159921399213I10E039C61 Patient presents with no complaints for “med check” - Levothyroxine is adjusted based on labs but no other treatment provided.
8/8/199921499214992159921499214I10E119I25.10E03.9Multiple issues addressed, treatment plan is inferred by multiple RX. Also treated I25.10 CAD, E03.9 Hypothyroid and E78.5 Hyperlipidemia but not listed on claim.
6/19/1999214992149921599214?I10N401K9041 Note completed by No Name, MA?

Accuracy - 42%

Comments: Notes by Dr. P are sometimes brief for HPI, need to include status of chronic conditions or details of presenting problem if acute. Treatment plan is not documented but sometimes can be inferred, other times not. Be sure to include plan for each DX treated and list all DX treated that day to support medical necessity for code. One note was not signed by MD but by MA? Diagnosis codes appropriately selected except as noted above.

Educational Session: Discussion with Dr. P included appropriate documentation of HPI and Assessment/Plan, use of most specific diagnoses and relation to treatment plan and EMR issues.

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