![]() ![]() Physician Compliance/Coding Support use Evaluation and Management (E/M) comparative data to evaluate Physicians/ACPs’ coding patterns and identify trends where additional analysis may be needed. Missing or insufficient documentation to support any E/M service or procedureĪudit Finding Points Description Delete CPT -100 No medical record documentation to support CPT code E/M No Code No medical record documentation to support an E/M service CPT Change – Overcode -80 Medical record documentation supports a different CPT code than selected, resulting in an overcode E/M Category Change – Overcode Medical record documentation supports an E/M code from a different E/M category, resulting in an overcode E/M Undercoded by 2-4 levels Medical record documentation supports a higher level E/M code than selected E/M Overcoded by 2-4 levels Medical record documentation supports a lower level E/M code than selected E/M Undercoded by 1 level -40 E/M Overcoded by 1 level E/M code change > one level, E/M code category changed High risk error: 100 point deduction. Reviewer changed the E/M code by one level Moderate risk error: 80 point deduction. The “points” scoring methodology allows Physician Compliance/Coding Support to prioritize education and follow up review based on identified risk(s). Typically, ten (10) encounters are reviewed per Physician/ACP each encounter is valued at 100 points, for a total of 1,000 possible points per audit. ![]() Points are weighted to reflect the risk that the error represents. Scoring When scoring a Physician/ACP’s chart review findings, a “points” system is used. Three (or more) consecutive audits fall below the 90% compliance threshold Two (or more) consecutive audits fall below the 90% compliance threshold Phase 4. Audit score falls below the 90% compliance threshold Phase 3. Compliance threshold (90%) met or exceeded Phase 2. Phase Process At the conclusion of each Physician/ACP review, the audit is scored and the compliance rate determines the “Phase” for the Physician/ACP. It provides an opportunity to examine a Physician/ACP’s documentation, identify issues, make recommendations to improve documentation, address any questions the Physician/ACP may have, and tailor any additional education, beyond the basic Coding and Documentation program presented to new Physicians/ACPs during Orientation. New Physician/ACP Orientation Team Corporate Compliance Revised October 2018īaseline score 100% Baseline score % Baseline score ≤89% *The baseline audit is performed for all new Physicians/ACPs within 60 days of joining Atrium Health. Presentation on theme: "Coding for New Physicians/ACPs"- Presentation transcript: ![]()
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