Best practices for coding audit reporting

June 2nd, 2020

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Note:  The following article synopsis was NOT provided by HCPro. It was created by Find-A-Code/innoviHealth.

Article Overview

This article covers the practical structure of coding audit reporting, including how audits are scoped, sampled, documented, summarized, and used to support compliance and education efforts. It is aimed at coding leaders, auditors, compliance staff, and others who need to interpret audit findings and communicate them appropriately across operational or legal audiences. The discussion also touches on data collection formats, report organization, and the types of issues commonly summarized in facility and physician audit contexts.

Why This Topic Matters

Clear audit reporting helps organizations evaluate coding accuracy, document compliance efforts, and identify where focused education or process improvement may be needed.

Article Sections

  1. Coding audits and their purpose

    Introduces the role of coding audits in monitoring accuracy, compliance, and education needs across different care settings.

  2. Auditing basics

    Summarizes the initial planning steps for an audit, including scope, time frame, sample size, and selection approach.

  3. Sample size

    Discusses considerations related to the number of cases reviewed and how review volume may vary by experience level and audit objective.

  4. Selection methodology

    Describes common ways audit samples may be chosen and the general categories of sampling methods used in practice.

  5. Data collection

    Covers how audit data may be organized for review, tracking, and trend analysis.

  6. Audit reporting

    Explains the purpose of the audit report and the need to tailor its detail and wording to the intended audience.

  7. History or background

    Outlines the opening portion of an audit report and the types of high-level questions it should address.

  8. Audit process

    Describes the process section of the report, including the policies, standards, and methods referenced in the review.

  9. Results

    Addresses how audit findings are summarized, including the types of trends and variances that may be reported.

  10. Next steps

    Covers follow-up actions after the audit, especially education and other efforts intended to address identified gaps.

What You Will Learn

  • How coding audits are used to support compliance and education
  • What to consider when defining audit scope and sample size
  • Common audit sampling and data collection approaches
  • How to organize the main parts of an audit report
  • How audit findings are typically summarized for different audiences
  • What follow-up actions may be taken after audit reporting

Who Should Read This

  • Coding auditors
  • Coding managers
  • Compliance staff
  • Physician practice administrators
  • Revenue cycle professionals
  • Healthcare compliance and legal reviewers

Codes Discussed

  • CPT: -25
  • CPT: -33

Modifiers Discussed

  • CPT: -25
  • CPT: -33

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