himagine Audit Services - Sample Report Packet - OP (1)

www.himaginesolutions.com

Reimagine Healthcare

CLIENT NAME

Sample OUTPATIENT REPORTING PACKAGE

September, 2016

COMPLIANCE & REIMBURSEMENT CODER PERFORMANCE IMPROVEMENT

Audited by: Auditor 1

AAMC Sample Reporting Audit Package 1

Confidential & Copyright, himagine solutions inc.

Contents

Outpatient Audit Accuracy Summary ....................................................................................................................... 2

Overall Outpatient Accuracy Trending ..................................................................................................................... 3

Outpatient Financial Impact Analysis ....................................................................................................................... 4

Outpatient Error Analysis ......................................................................................................................................... 5

Outpatient Diagnosis Error Analysis .................................................................................................................. 5

Outpatient CPT Error Analysis ............................................................................................................................ 6

Unspecified Diagnosis Code Analysis ....................................................................................................................... 6

Recommended Queries Table .................................................................................................................................. 8

Educational Recommendations ................................................................................................................................ 8

Outpatient Detail Outcome Reports ........................................................................................................................ 9

Coder Dashboard Reports ........................................................................................................................................ 9

Account Detail Report .............................................................................................................................................. 9



Outpatient Audit Reports

Outpatient Audit Accuracy Summary

200 Outpatient charts were audited in September 2016.

Overall accuracy was within compliance levels of 97.57%.

APC accuracy scores were strong at 98.53%.

Diagnosis coding accuracy was impacted by not following UHDDS guidelines for

reporting of secondary diagnosis.

CPT scores were below compliance levels at 90.91% due to incorrect coding of BiV

AICD insertion. All coders overall scores were above compliancy levels of 95% with the

exception of Coder 1 who was identified as struggling with BiV AICD insertion coding.

Scores for coder 1 were only slightly below the compliancy level at 94.85%

87.01%

90.91%92.57% 92.78%

99.53%98.53%

97.57%

80.00%

85.00%

90.00%

95.00%

100.00%

Diagnosis CPT / HCPCS Service Units Revenue Code Modifier APC Overall Accuracy

Coding Component Overall Accuracy Scores

94.85%

96.75%

97.45%

100.00%99.75%

92.00%

93.00%

94.00%

95.00%

96.00%

97.00%

98.00%

99.00%

100.00%

Coder 1 Coder 2 Coder 3 Coder 4 Coder 5

Coder Overall Accuracy Scores



Overall Outpatient Accuracy Trending

We have demonstrated consistent improvement from February through June across all components of

coding. This is reflective of the correctional coding education that has been provided to the coders to

enhance their skill set.

95.20%

95.80%96%

96.30%

96.70%

97.30%

January February March April May June

Outpatient Overall Facility Accuracy Trending



Outpatient Financial Impact Analysis

Decrease in under-coded charts has been identified from February through June. The decrease is

attributed to correctional education in the application of procedure codes for outpatient spinal

surgeries. Increase in overcoded charts was identified as being due the addition of a new service line at

AAMC for neurology. Coders have received education relating to the coding of these procedures and a

decrease on overcoded charts is expected.

($8,454.25)($16,252.85)

($43,280.85)

($67,987.95)

$13,563.41 $12,454.00 $7,135.85

$33,153.26

($80,000.00)

($60,000.00)

($40,000.00)

($20,000.00)

$0.00

$20,000.00

$40,000.00

February March April Total

Outpatient Financial Impact Analysis Trending

Overcoded Undercoded



Outpatient Error Analysis Outpatient Diagnosis Error Analysis

During the course of this audit, there were consistent issues with accurately assigning laterality for

injury coding which accounted for 36% of the errors captured. The highest source documentation was

the H&P at 38%. Coders have been instructed to fully read the H&P to capture all relevant information

needed for coding. Y/Z coding errors also demonstrated to be a source of additional required education

with regards to first listed diagnosis for chemotherapy totaling 21% of the diagnosis errors. ICD-10-CM

book chapter 23 was identified as the highest source of error which correlates to the Z code errors.

4 57

17

10

5

1

18

58

36

3 3

74

2

23

Ch

apte

r 1

Ch

apte

r 2

Ch

apte

r 3

Ch

apte

r 4

Ch

apte

r 5

Ch

apte

r 6

Ch

apte

r 7

Ch

apte

r 9

Ch

apte

r 1

0

Ch

apte

r 1

1

Ch

apte

r 1

3

Ch

apte

r 1

4

Ch

apte

r 1

5

Ch

apte

r 1

6

Ch

apte

r 1

8

Ch

apte

r 1

9

Ch

apte

r 2

0

Ch

apte

r 2

1

Diagnosis Variance Code Book Chapters

First Listed DX Revised - Incorrect

First Listed DX7%

First Listed DX Revised -Incorrect

Episode of Care14%

First Listed DX Revised -Laterality

Issue7%

SDX Deleted - Y / Z Code

21%

SDX Revised -Combination Code

10%

SDX Revised -Laterality

Issue36%

SDX Revised - Excludes 1 / 2 Error5%

Outpatient Diagnosis Variance Analysis

H&P38%

Discharge Summary

6%Consult

5%Op Note

7%

Progress Note7%

Radiology12%

Coding Clinic

7%

ER15%

Pathology3%

Diagnosis Error Source Documentation



Outpatient CPT Error Analysis

Unspecified Diagnosis Code Analysis

Incorrect surgical approach comprised 23% of the CPT procedure errors. A pattern was also identified in

coding in laterality with regards to application of modifiers which accounted for 23% of errors

captured. The source of these errors was further identified to be located in the Op note and Coding

Clinic directives. Coders were educated on the importance of capturing laterality modifiers and also

instructed to refer to all available Coding Clinics when unsure of the coding of surgical approaches and

CPT codes.

CPT Added16%

CPT Revised -Wrong surgical

approach23%

CPT Revised -Other10%

Unbundling of CPT codes

6%

Modifiers missing/incorr

ect for laterality

23%

PCS Revised -Laterality issue

10%

Education Opportunity

Only13%

Outpatient Procedure Variance Analysis

Op Note50%

Coding Clinic50%

Outpatient CPT Variance Source Documentation

Unspecified Codes16%

Specified Codes84%

Specified vs. Unspecified ICD-10-CM Code Variances

Revised - Coder Variance

3%

Deleted - Coder Variance

1%

Insufficient Documentation / Coder

Variance96%

ICD-10-CM Analysis of Unspecified Codes Assigned

Only 3% of unspecified codes were recommended to be deleted and 3% recommended being revised to

a higher level of specificity. The remaining unspecified codes that were applied were due to lack of

sufficient documentation to assign a code of higher specificity. Coders assigning of unspecified codes

was consistent based on the number of codes assigned. No outliers were identified.



57 48 73

178198153

228

579

0

100

200

300

400

500

600

700

Coder 1 Coder 2 Coder 3 Total

Specified vs. Unspecified ICD-10-CM Code Variances by Coder

Unspecified Codes Assigned Specified Codes Assigned

1

1

2

1

5

1

3

1

1

2

2

2

1

2

1

1

1

1

2

1

1

1

1

1

3

1

1

0 1 2 3 4 5 6

Malignant neoplasm of pancreas, unspecified

Malignant neoplasm of bladder, unspecified

Leiomyoma of uterus, unspecified

Iron deficiency anemia, unspecified

Anemia, unspecified

Hypothyroidism, unspecified

Hyperlipidemia, unspecified

Schizophrenia, unspecified

Bipolar disorder, unspecified

Major depressive disorder, single episode,…

Unspecified atrial fibrillation

Unspecified atrial flutter

Unspecified diastolic (congestive) heart failure

Heart failure, unspecified

Cerebral infarction, unspecified

Peripheral vascular disease, unspecified

Hypotension, unspecified

Unspecified bacterial pneumonia

Pneumonia, unspecified organism

Unspecified asthma, uncomplicated

Hepatic failure, unspecified with coma

Acute pancreatitis, unspecified

Non-prs chronic ulc unsp prt of r low leg w unsp…

Rheumatoid arthritis, unspecified

Acute kidney failure, unspecified

Unspecified ovarian cysts

Abnormal weight loss

ICD-10-CM Unspecified Codes Assigned



Recommended Queries Table

Educational Recommendations

Coding all 2nd diagnosis as documented to ensure accurate reporting was noted as a consistent pattern of error throughout this audit. Coders were sent coding Guidelines with regards to UHDDS guidelines for assigning of secondary diagnosis and instructed to review recorded field employee webinar titled ‘Back to Basics’ that is available to them

Chapter 15 (OB) code sequencing was an error repeated in two coders audits, Coder 1 and Coder 2. Recommended review of these guidelines along with recorded webinar on OB-GYN Coding.

Coding of BiV CRT devices was an error repeated in two coders audits, Coder 1 and Coder 2 Recommended additional education in these device implantation surgeries. The Vascular education PPT saved out on BOX explains these devices in detail.

Multiple procedures guideline application for PCS coding was a pattern of error in this audit along with PCS surgical approaches. Review of the PCS coding guidelines and surgical approaches was performed with these coders

Instructed coders to read the entire operative report. Coder 1 is assigning CPT/PCS codes

based on the ‘Procedures performed’ statement at the beginning of the OP note. This

resulted in deletion of CPT/PCS codes impacting the coders QA. This also resulted in addition

of CPT/CPS codes for procedures that were performed but not captured in the surgeon’s

initial procedure statement. This was reviewed with the coder.

One query was recommended during this audit for lesion size to assign the accurate CPT code.



Attachments

Outpatient Detail Outcome Reports

Coder Dashboard Reports

Account Detail Report

himagine Audit Services - Sample Report Packet - OP (1)

Documents