A Cautionary Tale
by AJ Riviezzo
A provider was audited by the Blues in their home state. They reviewed twenty charts. Not very many overall. Based on these twenty charts the determined that the level of coding for new patient and current patient office visits was not supported by the documentation. The Blues determined that instead of a 3 level code, they would only allow a 1 or 2 level code.
A dollar difference was determined and then applied to ALL of the office visit codes for the past three years. While an office visit may not be a large dollar item, and while the difference between the 2 level and the 3 level codes is not large either; when multiplied by a large number of office visits for three years… the dollar figure does indeed become large.
Given the various Medicare audits and the increasing reality of commercial audits, it is critical to ensure your charts match your coding.
Please have someone external review your charting. It is difficult to ‘proof’ your own work with an objective eye. In the above example the physician was spending a good bit of time with each patient. As such, this good doctor fully believe that this would justify the code levels selected. An internal audit would have supported that conclusion. Unfortunately an external audit conducted by personnel who do not already ‘know’ how much time is being spent will derive a different determination.
The above information is not designed to drum up business for my company. Please just use someone with good coding training that is external to your system to perform a bill-to-chart audit.
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