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Advanced E/M Auditing: Secrets to Success
Advanced E/M Auditing: Secrets to
Success
Presented by
Carrie Severson CPC, CPC-H, CPMA, CPC-I
Senior Auditor, AAPC Client Services
Advanced E/M Auditing: Secrets to Success
• OIG Report (OEI-04-10-00180)
• Coding Trends of Medicare Evaluation and
Management Services - May 2012
Why We Are Here
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Advanced E/M Auditing: Secrets to Success 3
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Advanced E/M Auditing: Secrets to Success 4
Advanced E/M Auditing: Secrets to Success 5
Advanced E/M Auditing: Secrets to Success 6
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Advanced E/M Auditing: Secrets to Success
• Compare your practice to your peers
• 20 most common coding and documentation errors
& how to avoid them
• The “Grey Areas”
• EHR pitfalls and what to look for in your audit
• Strategies for improving documentation and coding
• How to conduct an effective audit
Objectives
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Advanced E/M Auditing: Secrets to Success
Where does your practice fit?
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Advanced E/M Auditing: Secrets to Success
Where does your practice fit?
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Advanced E/M Auditing: Secrets to Success
Room for improvement
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Advanced E/M Auditing: Secrets to Success
The 20 most common coding and
documentation errors
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Advanced E/M Auditing: Secrets to Success
• Chief Complaint
• History of Present Illness
• Chronic Conditions
• Review of Systems
• Language
History Common Mistakes
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Advanced E/M Auditing: Secrets to Success
• Documentation
• Mixing
• Check boxes
• Understanding
Exam Common Mistakes
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Advanced E/M Auditing: Secrets to Success
• Severity and number
• Time based
• Orders
• Diagnosis
Assessment and Plan (MDM) Common Mistakes
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Advanced E/M Auditing: Secrets to Success
• Inconsistent documentation
• Abbreviations
• Counting elements
• Office procedures
• Misunderstanding of preventive services
• Authentication
• Timely
General Documentation Mistakes
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Advanced E/M Auditing: Secrets to Success
• Modifier misuse
• NCCI and LCD edits
• Diagnosis coding
• Chronic conditions
Coding & Data Entry Mistakes
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Advanced E/M Auditing: Secrets to Success
The “Grey Areas”
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Advanced E/M Auditing: Secrets to Success
• Fact or Fiction – The CC can be pulled from the
HPI.
Chief Complaint in HPI
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Advanced E/M Auditing: Secrets to Success
• Fact or Fiction – Status of 3 chronic conditions can
be used to support an extended level of history with
the ‘95 guidelines
Status of 3 Chronic Conditions
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Advanced E/M Auditing: Secrets to Success
• Fact or Fiction – If the history is unobtainable or non
contributory you can automatically bill a
comprehensive history
Unobtainable History
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Advanced E/M Auditing: Secrets to Success
• Fact or Fiction - If the nurse takes the HPI the
physician can then state, "HPI as above by the
nurse" or “Have read and agree with the HPI”
HPI Taken By Nurse
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Advanced E/M Auditing: Secrets to Success
• Fact or Fiction – A provider can count a single
history item in both the HPI and ROS
Double Dipping
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Advanced E/M Auditing: Secrets to Success
• Fact or Fiction – It’s acceptable to use the ‘97
Specialty specific exams for the comprehensive
exam of a single organ system in ‘95
Single Organ System Exam
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Advanced E/M Auditing: Secrets to Success
• Fact or Fiction – CMS defined the requirements of