tci ED Coding & Reimbursement Alert - 2013 Issue 8

Audit Strategies: Are These 2 HPI Glitches Putting You At Risk For E/M Audit Scrutiny?

How the “Acuity Caveat” could be sabotaging your documentation. As an ED coder, you’re facing heightened scrutiny from insurance company auditors who’re scouring E/M claims for documentation gaps in history of present illness. If your physicians adequately noteanatomic site details when patients present with illness and understand how to apply the acuity caveat, you’ll circumvent denials and down-coded claims. The challenge: Our industry has done a great job educating our physicians on the documentation requirements for the emergency department E/M codes, says Todd Thomas, CPC, CCS-P, President of the ERcoder, Inc. in Edmond OK. This...

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